tag:blogger.com,1999:blog-23212855348679212612019-09-12T01:43:50.491-07:00In ThoughtYour source for wellness tips, strategies, and news.Aaron Norton, LMHC, LMFThttp://www.blogger.com/profile/00635484623173913946noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-2321285534867921261.post-86723144932039150822016-05-09T14:18:00.001-07:002018-10-22T07:39:26.698-07:00The Political Beliefs of Mental Health Counselors<div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-G9pzcvOV_pE/Vypou9lclFI/AAAAAAAAAyA/adLN-_Zs7foSuK21ErtRr8qoSIPY7Xu6QCK4B/s1600/20141105_Republicanvs.Democrat.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="248" id="id_6fcf_2915_2c9b_ad97" src="https://4.bp.blogspot.com/-G9pzcvOV_pE/Vypou9lclFI/AAAAAAAAAyA/adLN-_Zs7foSuK21ErtRr8qoSIPY7Xu6QCK4B/s320/20141105_Republicanvs.Democrat.jpg" style="height: auto; width: 320px;" width="320"></a></div><br><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">On more than a few occasions, I've heard clients and prospective clients talk about avoiding counseling because they expected the counselor to impose a biased worldview. &nbsp;This has been particularly notable among politically or religiously conservative clients. &nbsp;Apparently, some of them have been exposed to the same stereotypes about counselors that those of us who work in the profession have been exposed to; the image of a liberal intellectual--perhaps formerly a hippie--who is vaguely spiritual but clearly opposed to organized religion, espousing a worldview of moral relativism. &nbsp;</span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">But is there any truth to these stereotypes? &nbsp;If so, is there any evidence that they impact the quality or nature of the therapeutic relationship between counselor and client?</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">To find out, I started by looking for research published in peer-reviewed professional journals that might shed light on the political beliefs of mental health professionals. &nbsp;I discovered that in previous studies the majority of <a href="http://www.jstor.org/stable/42659620?seq=1#page_scan_tab_contents" target="_blank">social workers</a>, <a href="http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&amp;id=2003-02090-005" target="_blank">clinical and counseling psychologists</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1002/j.2161-007X.2011.tb01031.x/abstract;jsessionid=1AB68161A44D68A1552441F62F1AC581.f04t04" target="_blank">school counselors</a>, and <a href="http://link.springer.com/article/10.1007%2Fs10447-014-9217-0" id="id_cf84_3965_1da9_80cb" target="_blank">professional counselors and counselor educators</a> identified as politically liberal, which wasn't very surprising.</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">What I was surprised to discover is how little research I could find on the <i>implications</i> of this correlation. &nbsp;How does the dominance of liberal political ideology impact the field of mental health counseling? &nbsp;How does it affect interactions between counselor and client? &nbsp;How does it manifest in the classrooms of counseling students? &nbsp;How does it influence what and how counseling researchers explore?</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">I decided these might be some interesting questions to explore, so I designed the first in what may be a series of studies designed to at least partially answer these questions. &nbsp;I started with exploring the question of how political ideology might influence counseling sessions. &nbsp;I wanted to see if there was any connection between the political beliefs of Licensed Mental Health Counselors and their preferred counseling theories.</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">Basically, counseling theories are beliefs and assumptions about people and their problems, and more specifically how to help people accomplish their goals. &nbsp;For readers who are not already familiar with them, let me offer a brief summary of theses approaches:</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span></span><br><ul><li><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><a href="http://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/" target="_blank">Cognitive-Behavioral</a>: Teach people strategies to identify unhealthy thoughts and behaviors and replace them with healthier alternatives.</span></li><li><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><a href="http://www.goodtherapy.org/blog/experiential-theory-is-psychotherapys-well-kept-secret-0307125/" target="_blank">Experiential</a>: Provide people with therapeutic experiences that help them to resolve emotional problems.</span></li><li><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><a href="http://www.goodtherapy.org/learn-about-therapy/types/humanistic-psychology" target="_blank">Humanistic</a>, <a href="http://www.goodtherapy.org/learn-about-therapy/types/existential-psychotherapy" target="_blank">Existential</a>, and <a href="http://www.goodtherapy.org/learn-about-therapy/types/constructivism" target="_blank">Constructivist</a>: Help people tap into their internal resources by finding meaning or purpose, identifying what they really want or need, and/or adopting strategies or stories that help them accomplish their goals.</span></li><li><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><a href="http://www.goodtherapy.org/learn-about-therapy/types/mindfulness-based-approaches-contemplative-approaches" target="_blank">Mindfulness-Based</a>: Teach people to be aware in the present moment of their thoughts and emotions without judging them.</span></li><li><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><a href="http://www.goodtherapy.org/learn-about-therapy/types/psychodynamic" target="_blank">Psychodynamic</a>: Help people develop insight into the developmental experiences and subconscious processes that contribute to their present suffering so that those patterns can be interrupted.</span></li><li><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><a href="http://www.goodtherapy.org/learn-about-therapy/types/systems-theory-therapy" target="_blank">Systems</a>: Help people to understand the role each member of a system (e.g., family or relationship) plays in the functioning of that system as a whole and interrupt processes that negatively affect the system.</span></li></ul><div><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">To date, I have found only <a href="http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&amp;id=2003-02090-005" target="_blank">one study</a> that examined the relationship between the political beliefs of mental health professionals and their preferred counseling theories, but the study was conducted with psychologists rather than counselors, the sample size was too small to carry a strong effect size, and I also didn't like that the study used a unidimensional approach to categorizing political ideology ranging from liberal to conservative. &nbsp;I prefer a bi-dimensional approach that includes labels for political ideologies that mix conservative and liberal beliefs (e.g., </span><span style="font-family: &quot;helvetica&quot;;">libertarianism). &nbsp;<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">For example, on the traditional unidimensional spectrum ranging from conservative on one of the spectrum to liberal on the other, a libertarian who is economically conservative but socially liberal falsely appears moderate or centrist, when in fact he or she tends to take extreme positions depending on the whether the issue is social or economic in nature. A bidimensional approach eliminates this type of illusion. &nbsp;Finally, I wanted to know more about some of the more specific political beliefs of counselors than the previous study explored. &nbsp;</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">For my study, I surveyed 490 Licensed Mental Health Counselors in Florida, asking them how they identified their political ideology (conservative, liberal, moderate, libertarian, communist, etc.), how much they believed their political beliefs influenced their counseling theories, and which political party they last registered with. &nbsp;I then asked them to rank-order the six counseling theories above from least to most preferred. &nbsp;Lastly, I asked them to rate how much they agreed or disagreed with 14 political statements related to social and economic freedom on an individual level. &nbsp;</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">I developed five hypotheses about what I would find and reported on whether or not the data collected supported those hypotheses. &nbsp;I created a manuscript of my findings and submitted it to the Journal of Mental Health Counseling in hopes that it would be published. &nbsp;As of this writing, I'm still awaiting a response.</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><b>Hypothesis 1: Mental health counselors are more likely to identify as liberals than as conservatives.</b></span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><b><br></b></span></span><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">This hypothesis was supported by the data. &nbsp;Nearly 52% of counselors described themselves as liberal, and only 20% of the sample described themselves as conservative. &nbsp;Also, 54% of counselors reported that they were registered Democrats, whereas 23% were registered as Republicans.</span></span></span><br><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/--c_sxFLyH_A/Vy4eO0ZXnKI/AAAAAAAAAzs/V3USYGmhv7cqNhVniFGhq64A_o8C9ds8ACLcB/s1600/Chart_Q9_160507.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><img border="0" height="280" id="id_190f_860_c14a_6792" src="https://1.bp.blogspot.com/--c_sxFLyH_A/Vy4eO0ZXnKI/AAAAAAAAAzs/V3USYGmhv7cqNhVniFGhq64A_o8C9ds8ACLcB/s400/Chart_Q9_160507.png" style="height: auto; width: 400px;" width="400"></span></a></div><div class="separator" style="clear: both; text-align: center;"><a href="https://4.bp.blogspot.com/-GYGC8Ci8RDk/Vy4e4GoRd4I/AAAAAAAAAzw/SX2llGprybMO0huAR4_l40VIZyLDTohdQCLcB/s1600/Chart_Q10_160507.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><img border="0" height="310" id="id_70e8_18fe_3fc4_6a49" src="https://4.bp.blogspot.com/-GYGC8Ci8RDk/Vy4e4GoRd4I/AAAAAAAAAzw/SX2llGprybMO0huAR4_l40VIZyLDTohdQCLcB/s400/Chart_Q10_160507.png" style="height: auto; width: 400px;" width="400"></span></a></div><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span></span><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span></span><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><b>Hypothesis #2: A majority of mental health counselors will report a perception that their political ideology influences their counseling theory.</b></span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><b><br></b></span></span><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">Only about 30% of mental health counselors reported that they don't think their political ideology influences their counseling theory at all. &nbsp;The remaining 70% believe that their political beliefs at least partially influence their counseling theory.</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span></span></span><br><div class="separator" style="clear: both; text-align: center;"><a href="https://2.bp.blogspot.com/-4EaGDtjLMM8/Vy5vCLQ1l9I/AAAAAAAAA0M/DPoPTymRNf4m_tk3ksLYqCz4Qy0UK37bwCLcB/s1600/Chart_Q11_160507.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><img border="0" height="311" id="id_c979_bb66_a7f9_90ae" src="https://2.bp.blogspot.com/-4EaGDtjLMM8/Vy5vCLQ1l9I/AAAAAAAAA0M/DPoPTymRNf4m_tk3ksLYqCz4Qy0UK37bwCLcB/s400/Chart_Q11_160507.png" style="height: auto; width: 400px;" width="400"></span></a></div><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><b>Hypotheses 3 and 4: Liberal mental health counselors will be more likely to prefer humanistic and experiential counseling theories, and conservative counselors will be more likely to prefer cognitive behavioral theory.</b></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span></span><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">The first thing I learned when I explored preferred counseling theories is that cognitive behavioral theory was the most preferred counseling theory among the six options I gave counselors. &nbsp;The bar graph you see below provides the average rating given by counselors in my sample on a scale of 1 to 6. &nbsp;As you can see, cognitive behavioral theory was most popular, followed by humanistic/existentialist/constructivist, mindfulness-based, systemic, psychodynamic, and experiential theories in that order.</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span></span></span><br><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-vNWcRokOtk8/VzDoYPlml7I/AAAAAAAAA04/QZitUIWafrA_h6BKZ6n9Gm7dDICeCQiZACLcB/s1600/Chart_Q8_160509.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><img border="0" height="380" id="id_7505_6e3b_8dc4_3fd3" src="https://1.bp.blogspot.com/-vNWcRokOtk8/VzDoYPlml7I/AAAAAAAAA04/QZitUIWafrA_h6BKZ6n9Gm7dDICeCQiZACLcB/s400/Chart_Q8_160509.png" style="height: auto; width: 400px;" width="400"></span></a></div><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;">Next, I used statistical procedure called a </span><a href="http://stattrek.com/chi-square-test/independence.aspx?Tutorial=AP" style="line-height: 17.12px;" target="_blank">chi square test for independence</a><span style="line-height: 17.12px;">&nbsp;to try and determine whether or not there was any statistically significant relationship between political ideology and each counseling theory. &nbsp;This test demonstrated a significant relationship with only two of the counseling theories; cognitive-behavioral and mindfulness-based. &nbsp;As a rule of thumb, in the social sciences we consider a relationship between two variables to be significant if we can obtain a Pearson chi-square value of 0.05 or less, which literally means that the probability that two variables are unrelated is 5% of less. &nbsp;The value I obtained for cognitive&nbsp;behavioral theory and political ideology was 0.00, meaning that there is approximately a 0% likelihood that the two variables are not related. &nbsp;The value I obtained for mindfulness-based theory and political ideology was 0.009, meaning that the probability that the two variables are unrelated is less than 1%.</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><br></span></span><span style="line-height: 17.12px;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">To find out exactly what that relations</span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">hip was, I had to dig a little deeper and look at ratios. &nbsp;I discovered that of</span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;">&nbsp;the 232 counselors who describe themselves as liberal, 159 (68.5%) selected cognitive behavioral theory as their first or second most preferred counseling theory compared to 81 of 89 (91%) conservative counselors.</span><span style="line-height: 107%;">&nbsp; Twenty (8.6%) liberal counselors and three (3.37%) conservative counselors least preferred cognitive&nbsp;</span><span style="line-height: 17.12px;">behavioral</span><span style="line-height: 107%;">&nbsp;theory. &nbsp;In&nbsp;other words, <b>although cognitive behavioral theory was the most popular theory among both conservatives and liberals, conservatives preferred it much more than liberals on average</b>.</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;">I also discovered that 34 of the 232 (14.66%) liberal counselors most preferred mindfulness-based counseling theories, compared to 3 of the 89 (3.37%) conservative counselors. &nbsp;Four of the 232 (1.72%) liberal counselors least preferred mindfulness-based counseling theories, compared to 3 of 89 (3.37%) conservative counselors. &nbsp;In other words,<b> liberal counselors tended to prefer mindfulness-based counseling theories more than conservative counselors</b>.</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;">When I examined the relationship between political party affiliation and cognitive behavioral theory, I found similar results. &nbsp;The probability that the two were unrelated was approximately 0%. &nbsp;Eighty-seven of the 102 (85.29%)&nbsp;</span><span style="line-height: 17.12px;">counselors</span><span style="line-height: 107%;">&nbsp;who reported that they were&nbsp;registered Republicans selected cognitive behavioral theory as their first or second preferred theory, compared to 176 of 241 (73.03%) counselors who were registered Democrats.&nbsp; Six of the 102 (5.88%) Republican counselors least preferred cognitive behavioral theory, compared to 16 of the 241 (6.64%) Democrat counselors. &nbsp;In other words, <b>although both Democrats and Republicans favored cognitive behavioral theory, Republicans favored it much more than Democrats</b>.</span><br><span style="line-height: 107%;">&nbsp;</span></span></span><br><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">Surprisingly, I did not find that Democrats were any more likely to prefer mindfulness-based counseling theories than Republicans, despite that liberal counselors were more likely than conservative counselors to prefer it.</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span></span><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">I did not find any significant relationship between any other counseling theory and political ideology nor party affiliation (i.e., humanistic/existentialist/constructivist, psychodynamic, experiential, and systemic theories).</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span></span></span><br><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><b>Hypothesis #5: Mental health counselors will be more likely to support political statements reflective of high levels of individual social freedom than those reflective of high levels of individual economic freedom.</b></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;">I asked counselors to rate how much they agree with 14 political statements on a scale of 1 to 5. &nbsp;Seven of those statements were designed to support high levels of individual economic freedom, and the other seven were designed to support high levels of individual social freedom. &nbsp;These statements are similar to items in <i><a href="http://www.politicalcompass.org/" target="_blank">The Political Compass</a></i> and <i><a href="https://www.theadvocates.org/quiz/quiz.php" target="_blank">The World's Smallest Political Quiz</a>. &nbsp;</i>Below, you'll see the average rating counselors gave each item on that scale from 1 to 5.</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><br></span></span></span><br><div class="separator" style="clear: both; text-align: center;"><a href="https://2.bp.blogspot.com/-gBup61ApFRA/VzEmhQbENCI/AAAAAAAAA2A/gXRhE06IDTgfh9HKVgeq_qe1mwjdbN08QCLcB/s1600/2016-05-09%2B%25281%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><img border="0" height="382" src="https://2.bp.blogspot.com/-gBup61ApFRA/VzEmhQbENCI/AAAAAAAAA2A/gXRhE06IDTgfh9HKVgeq_qe1mwjdbN08QCLcB/s400/2016-05-09%2B%25281%2529.png" width="400" id="id_bcd8_b80e_e847_621e" style="width: 400px; height: auto;"></span></a></div><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif; line-height: 17.12px;">As I anticipated, <b>counselors were more likely to endorse items supporting social freedom (freedom to make lifestyle choices without government&nbsp;interference) than economic freedom (freedom to&nbsp;make choices about how to spend one's income).</b></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><b><br></b></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;">I used the data obtained from these 14 items to create a <a href="https://en.wikipedia.org/wiki/Nolan_Chart" target="_blank">Nolan Chart</a>, which is essentially a <a href="https://en.wikipedia.org/wiki/Scatter_plot" target="_blank">scatter plot</a> providing a graphical representation of where each counselor stands on a bi-dimensional spectrum that separates counselors into four quadrants based on endorsement of beliefs supportive of freedom on an individual level.</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;">(1) <b>Communitarian Quadrant</b>: low social freedom and low economic freedom;</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif; line-height: 17.12px;">(2) <b>Liberal Quadrant</b>: high social freedom and low economic freedom;</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif; line-height: 17.12px;">(3) <b>Conservative Quadrant</b>: low social freedom and high economic freedom;</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif; line-height: 17.12px;">(4) <b>Libertarian Quadrant</b>: high social freedom and high economic freedom.</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><br></span></span></span><br><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-435lV_Hc8Os/VzDxjaZCXHI/AAAAAAAAA1Q/Hy1bIYLutb8R7lw3xMxERUf-jKgb20RNwCLcB/s1600/2016-05-09.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><img border="0" height="375" id="id_9b4e_ca5b_9539_3d9a" src="https://1.bp.blogspot.com/-435lV_Hc8Os/VzDxjaZCXHI/AAAAAAAAA1Q/Hy1bIYLutb8R7lw3xMxERUf-jKgb20RNwCLcB/s400/2016-05-09.png" style="height: auto; width: 400px;" width="400"></span></a></div><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif; line-height: 17.12px;">When I grouped all of those data points into just one point on the same chart that represented the average counselor's position, I came up with the chart below, which depicts the average counselors as a moderate liberal:</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><br></span></span></span><br><div class="separator" style="clear: both; text-align: center;"><a href="https://4.bp.blogspot.com/-3R7nibiOSdg/VzD0b0tQ2kI/AAAAAAAAA1k/KWuE3uWtNYMs6Lg0CUQiTmlmzla4NR39ACLcB/s1600/2016-04-24.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><img border="0" height="400" id="id_3f5e_9a5e_cd5d_501b" src="https://4.bp.blogspot.com/-3R7nibiOSdg/VzD0b0tQ2kI/AAAAAAAAA1k/KWuE3uWtNYMs6Lg0CUQiTmlmzla4NR39ACLcB/s400/2016-04-24.png" style="height: auto; width: 397px;" width="397"></span></a></div><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif; line-height: 17.12px;"><b>Limitations and Flaws of the Study</b></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><b><br></b></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;">My study has several limitations and flaws. &nbsp;First, any study that relies on email responses to a survey runs the risk of <a href="https://en.wikipedia.org/wiki/Sampling_bias" target="_blank">sampling bias</a> and <a href="http://study.com/academy/lesson/volunteer-bias-in-psychology-definition-lesson.html" target="_blank">volunteer bias</a>. &nbsp;Basically, any counselor who doesn't have access to email or who did not report his or her email address to the licensing board did not receive the invitation to participate. &nbsp;What if those counselors, few as they may be, would have made a difference in my results? &nbsp;Also, what if the counselors who chose not to participate in the study are substantially different from those who took the time to participate? &nbsp;What if, for example, the counselors who participated are more passionate about politics (and possibly less moderate)? &nbsp;</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;">Second, this study tells us nothing about causation, it only tells us about correlation. &nbsp;In other words, we don't know if conservative political ideology causes a stronger preference for cognitive behavioral counseling theories; We only know the two variables are strongly related somehow. &nbsp;Personally, I suspect that both counseling theory and political ideology are subsets of a broader concept of worldview--a person's overall philosophies of life, or beliefs in how and what people and the world are or should be like.</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;">Third, it's possible that counselors aren't very accurate in applying labels that describe their political beliefs. &nbsp;What if, for example, the counseling profession tends to attract people who are less politically-informed or politically neutral, and such individuals don't know enough to accurately self-report on their political beliefs? &nbsp;Personally, I strongly doubt this possibility is true, as counselors tend to be educated individuals who care a lot about society, but I can't say that I <i>know for certain</i> that this is the case.</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;">Lastly, it could be argued that the 14 items I selected and the model I employed to divide counselors into four quadrants is flawed, irrelevant, or perhaps biased. &nbsp;I think this is a valid perspective in the sense that by definition models are ways of conceptualizing phenomena that are often rooted in preference and are therefore at least partially subjective in nature. &nbsp;Also, the Nolan Chart that I used to illustrate responses was created by the founder of the Libertarian Party, and as such could raise questions as to whether the model is biased to favor libertarians.</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;">That being said, I certainly uncovered a great deal of evidence that many in the political science field support bidimensional models like the model I used over the traditional unidimensional model that rates political ideology on one spectrum from liberal to conservative (e.g., <a href="http://onlinelibrary.wiley.com/doi/10.1111/pops.12055/abstract" target="_blank">Feldman &amp; Johnston, 2014</a>; <a href="http://poq.oxfordjournals.org/content/73/4/679.short" target="_blank">Treier &amp; Hillygus, 2009</a>), and my reasoning for avoiding this reductionist approach seems sound and reasonable (see paragraph 8). &nbsp;Also, my experience thus far is that at first glance most people who pay a great deal of attention to politics look at the 14 items I selected and consider them to be relevant in terms of understanding an individual's political ideology, and the items were based on items in popular political surveys, suggesting <a href="https://en.wikipedia.org/wiki/Face_validity" target="_blank">face validity</a>. &nbsp;And at the very least, these 14 items tell us <i>something</i> about the political beliefs of counselors.</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><b>What Might These Findings Say About the Counseling Profession?</b></span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 17.12px;"><b><br></b></span></span><span style="line-height: 17.12px;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">I have several theories bout why most of my hypotheses were supported by the data, and what they mean. &nbsp;</span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">First, several researchers have&nbsp;</span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;">asserted that <a href="http://www.scientificamerican.com/article/calling-truce-political-wars/" target="_blank">conservatives may be more attuned to threat than liberals</a> and may prefer order and structure as a means of countering chaos, whereas <a href="http://www.huffingtonpost.com/entry/liberals-and-conservatives-brains-solve-problems-differently_us_56f00b95e4b09bf44a9dd89f" target="_blank">liberals may have a greater preference for openness and novelty-seeking</a>.</span><span style="line-height: 107%;">&nbsp;&nbsp;</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;">If these findings are accurate, then one might expect conservatives to be attracted to the structured, orderly, and methodical approach of cognitive behavioral therapy, in which cognitive distortions, irrational thoughts, and maladaptive behaviors can be identified, targeted, extracted, countered, and/or replaced.</span><span style="line-height: 107%;">&nbsp; </span><span style="line-height: 107%;">Conversely, liberals may be somewhat more likely to spread their preferences out over a variety of counseling theories with less regimented approaches.</span><span style="line-height: 107%;">&nbsp; </span><span style="line-height: 107%;">They may be attracted to the idea of acknowledging and accepting unpleasant thoughts and feelings with a nonjudgmental stance, as mindfulness-based approaches emphasize.</span></span></span></div><div><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span></div><div><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;">Also, because <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673298/" target="_blank">cognitive behavioral therapy is so well-researched and popular</a> in counselor education programs, conservative counselors may view it as a "safe bet" of sorts, preferring it to other approaches with less empirical support.</span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><br></span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif; line-height: 107%;">Are there benefits to liberal bias in the counseling profession? &nbsp;Do liberals tend to make better counselors somehow? &nbsp;Why does the profession attract more liberals than conservatives? &nbsp;These are interesting questions to explore, although they may also feel threatening to conservative counselors, counseling students, and counselor educators. &nbsp;But even if there were advantages to the liberal lean in the counseling profession, there may also be several drawbacks. &nbsp;</span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;">A popular team of researchers on moral reasoning recently <a href="http://www.rci.rutgers.edu/~jussim/Duarte%20et%20al,%202015,%20BBS,%20target,%20commentaries,%20reply.pdf" target="_blank">published a position paper</a>&nbsp;</span><span style="line-height: 107%;">asserting that the field of social psychological science has progressively become less politically diverse (i.e., more politically liberal) over time, and that this lack of political diversity contributes to bias that sometimes harms the profession.</span><span style="line-height: 107%;">&nbsp;&nbsp;&nbsp;</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;">Could the same be true for the counseling profession?</span><span style="line-height: 107%;">&nbsp; I believe that&nbsp;</span><span style="line-height: 107%;">the following research questions related to political homogeneity may be useful in exploring this further:&nbsp;</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><br></span></span></span><br><ol><li style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif; line-height: 107%;">(How might the relationship between counseling theory and political ideology manifest in the therapy room (e.g., whether or not clients tend to have better outcomes when matched with a counselor with a similar political ideology or worldview, differences in decision-making or case conceptualization by counselors with varying political ideologies);&nbsp;</span></span></span></li><li><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif; line-height: 107%;">Does the lack of political diversity in our field negatively impact research in mental health counseling (e.g., biased questionnaires or experimental research, lack of research in areas more likely to be appealing to conservative counselors and researchers, confirmation bias, etc.)?&nbsp;</span></span></span></li><li><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif; line-height: 107%;"><span style="line-height: 107%;">How might this lack of political diversity impact counselor education (e.g., intentional or unintentional&nbsp;</span><span style="line-height: 17.12px;">gate-keeping</span><span style="line-height: 107%;">&nbsp;by liberal educators, fear of genuine disclosure by counseling students&nbsp;with a minority political belief system, biased education on topics with a strong connection to political issues)?</span></span></span></li><li><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif; line-height: 107%;">How might political homogeneity impact the actions and positions of counseling associations?</span></span></span></li></ol><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><br></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;">To illustrate this fourth question,&nbsp;</span><span style="line-height: 107%;">when the Affordable Care Act was passed into legislation, the American Counseling Association (ACA), <a href="https://www.counseling.org/about-us/about-aca" target="_blank">the largest professional association representing counselors</a>, released a statement to its members entitled <i><a href="http://www.counseling.org/PublicPolicy/PDF/What_counselors_should_know-the_Affordable_Care_Act_12-12.pdf" target="_blank">The Affordable Care Act: What Counselors Should Know</a></i>.&nbsp; The flyer described several ways the legislation would benefit counselors and clients. Concurrently, several news stories, briefs, articles, and books were published with information on how the legislation could also adversely impact mental health counselors, especially those working in private practice (e.g., <a href="http://www.amazon.com/Endangered-Private-Practice-Surviving-Health/dp/076570935X" target="_blank">Hixson, 2013</a>; <a href="http://psycnet.apa.org/psycinfo/2012-24749-001/" target="_blank">Nordal, 2012</a>; <a href="http://www.aamft.org/HealthcarePart1.pdf" target="_blank">Rasmussen, 2013</a>; <a href="https://www.psychotherapynetworker.org/magazine/article/145/clinicians-digest" target="_blank">Rodriguez, 2014</a>; <a href="http://www.npr.org/sections/health-%20shots/2013/10/24/234737302/therapists-explore-dropping-solo-practices-to-join-groups" target="_blank">Varney, 2013</a>).&nbsp; Given that <a href="http://www.counseling.org/publications/aca_2012_exhibitor_prospectus%20_media_kit.pdf" target="_blank">private practice was the second most prevalent work setting among the ACA’s membership in 2011</a>, it is reasonable to question why the ACA did not inform its members of the potential drawbacks of the legislation and whether this intentional or unintentional omission may be related to political bias resulting from the lack of political diversity in the profession. &nbsp;</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><br></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;">Don't counselors deserve for their professional associations to give them objective and balanced information about issues that face them? &nbsp;If counseling associations fail to do so, will legislators begin to view them as biased mouthpieces of political parties? &nbsp;If they lose credibility, do they lose influence on important issues of professional advocacy? &nbsp;These are important questions to explore in a profession that lacks political diversity.</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><br></span></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;">As I mentioned earlier, I anticipate that I will be conducting a few more studies to explore some of the questions I posed above. &nbsp;I'm also hoping that others will design similar studies so that we can learn more about benefits and drawbacks of political diversity in the counseling profession. &nbsp;If you're interested in this line of research, stay tuned.</span><span style="line-height: 107%;">&nbsp;</span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><br></span></span></span><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><b>Update 8/19/16</b></span></span></span><br><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="font-family: &quot;helvetica neue&quot; , &quot;arial&quot; , &quot;helvetica&quot; , sans-serif;"><span style="line-height: 107%;"><b><br></b></span></span></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><div>My manuscript was not selected for publication by the <i>Journal of Mental Health Counseling</i>, primarily because they did not think I had gone far enough in my statistical analysis. &nbsp;I resubmitted the manuscript to <i>Counseling Values</i>, which may be a more appropriate fit in terms of content and am still awaiting a response.</div><div><br></div>In an attempt to increase the validity of my findings, I performed some additional analysis on the 14 political statements that I asked counselors to respond to. A one-way analysis of variance was conducted to evaluate the relationship between scores on the economic freedom and social freedom scales of the political beliefs questionnaire and the reported political ideology of participants. The independent variable, the reported political ideology of the participants, included six categories: communist, socialist, liberal, moderate, conservative, and libertarian. The dependent variables include the scores on the economic freedom and social freedom scales. The ANOVA was significant, F (5, 394) = 4.79, p =0.00. This result indicated that the economic freedom and social freedom scores among these six political groups were different. &nbsp;In other words, counselors who report different political ideologies were likely to respond differently on the 14 items I selected.</span></div><div><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br></span></div><div><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Update 10/9/18</b></span></div><div><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br></span></div><div><font face="Helvetica Neue, Arial, Helvetica, sans-serif">I partnered with Dr. Tony Tan at the University of South Florida to improve the statistical analyses of this study, and&nbsp;</font><a href="http://psycnet.apa.org/record/2018-41156-001" id="id_8cce_e681_d896_c4e">our manuscript has since been published</a><font face="Helvetica Neue, Arial, Helvetica, sans-serif">&nbsp;in the <i>American Journal of Orthopsychiatry</i>. &nbsp;We are helpful that it will be useful in furthering discussion and research in this are of inquiry. &nbsp;</font></div>Aaron Norton, LMHC, LMFThttp://www.blogger.com/profile/00635484623173913946noreply@blogger.com20tag:blogger.com,1999:blog-2321285534867921261.post-52597551163625148312014-09-17T21:23:00.000-07:002014-09-17T21:23:11.082-07:00September Letter from the President<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Reposted from Suncoast Mental Health Counselors Association (SMHCA)&nbsp;</span><br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Greetings, SMHCA members!</span><br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Last month, I had the pleasure of attending a FMHCA planning retreat in Orlando, which really helped me to organize some of my goals and objectives for 2014-2015 as the incoming President. &nbsp;Based on feedback I've collected from members of both FMHCA and SMHCA, I've developed a list of seven objectives I have for the upcoming year. &nbsp;I'd like to share them with you and invite you to be part of the dialogue. &nbsp;I'd love to hear any ideas, recommendations, suggestions, or criticism that members would like to share as we go forward into what I am confident will be another productive and meaningful year for our chapter.</span><br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">(1)<span class="Apple-tab-span" style="white-space: pre;"> </span>Expand training and professional development opportunities. &nbsp;I love working in a profession in which one can never say, "I've learned it all." &nbsp;SMHCA already offers our members quality continuing education with dynamic, informed presenters. &nbsp;In addition to the three CEUs offered at every monthly meeting, we have sponsored or co-sponsored a number of special events for continuing eduction, such as the Spring Symposium, the 5th Annual Institute on Counseling the Military, Families, and Children, and the four-hour DSM-5 training we offered at the University of South Florida as a service to students and alumni. &nbsp;I'd also love to see SMHCA provide live-streaming cyber training and webinars "on demand" for our members who can't travel to our training events.&nbsp;</span><br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">(2)<span class="Apple-tab-span" style="white-space: pre;"> </span>Increase, inspire, and invigorate chapter membership. &nbsp;There is power in numbers. &nbsp;There are 2,076 LMHCs and an additional 1,991 registered mental health counselor interns in the five counties served by SMHCA. &nbsp;If even a third of those professionals were members of SMHCA, our membership would expand by 1,200 &nbsp;professionals, and that's not including the unknown number of counseling students in our coverage area! &nbsp;I'm not just interested in expanding membership; I'd also like to increase membership participation. &nbsp;I know that our members have creative potential, and I'd like to see that energy in action.</span><br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">(3)<span class="Apple-tab-span" style="white-space: pre;"> </span>Foster a stronger relationship with the local Veterans Affairs (VA) programs. &nbsp;LMHCs are the newest behavioral health professionals to be included in the VA's mental health treatment family. &nbsp;I want to educate the VA on the many benefits of hiring LMHCs and maintain a direct line of communication between the VA hiring personnel and SMHCA members who are interested in joining the VA's workforce. &nbsp;I also envision a symbiotic referral relationship between the VA and LMHCs in agency and private practice settings.</span><br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">(4)<span class="Apple-tab-span" style="white-space: pre;"> </span>Increase the public's familiarity with the specialty of clinical mental health counseling. &nbsp;Understandably, the average client in need of mental health treatment is confused about the difference between LMHCs and other allied therapeutic professionals, such as LCSWs, LMFTs, psychologists, psychiatrists, and psychiatric ARNPs. &nbsp;Frankly speaking, many healthcare professionals know very little about LMHCs, our scope of practice, and how our services play an integral role in the healthcare industry. &nbsp;I'd love for every LMHC to be able to articulate a reasonable explanation of what LMHCs bring to the table. &nbsp;Last year, Past President Mary Lutzo and other SMHCA members distributed brochures they designed to facilitate this dialogue, making them available to our membership. &nbsp;I'd like SMHCA to provide local LMHCs with additional tools to promote our profession.</span><br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">(5)<span class="Apple-tab-span" style="white-space: pre;"> </span>Promote and expand the Colleague Collaboration program. &nbsp;Peer supervision and collaboration is a tremendous benefit, especially for our members who work in private practices that can sometimes be very isolating. &nbsp;It seems as though this opportunity is under-utilized by our membership, and I'd love to see more participation.</span><br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">(6)<span class="Apple-tab-span" style="white-space: pre;"> </span>Foster a stronger relationship between SMHCA and its state and national affiliates, FMHCA and AMHCA. &nbsp;The efforts of our state and federal affiliates trickle down to local practitioners. &nbsp;There are tremendous disparities and threats to our profession that need to be addressed on those levels in order for us to secure our place at the table in the national healthcare industry. &nbsp;LMHCs should be able to bill Medicare just as LCSWs and psychologists do. &nbsp;We are dramatically under-represented in the VA system, and many branches of the armed services, such as the U.S. Air Force, hire psychologists, psychiatrists, social workers, and nurse practitioners as medical officers while excluding licensed professional counselors. &nbsp;Psychologists have made several unsuccessful attempts to prevent LMHCs from administering tests that measure personality and pathology constructs despite our training in assessment and evaluation. &nbsp;As FMHCA's "chapter of the year" for two consecutive years, I'd love to see our members take a more active role in FMHCA activities, and I'd love to increase dual membership.</span><br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">(7)<span class="Apple-tab-span" style="white-space: pre;"> </span>Revise and update chapter By-Laws. &nbsp;A subcommittee consisting of Mary Lutzo, Past President Misty Fenton, Jay Schrader, and Cristina Gonzalez was formed last spring and has been working hard over the summer to develop a list of recommended changes to our by-laws. &nbsp;I anticipate that we will be examining their recommendations during our September meeting.</span><br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">I don'w know about you, but I'm looking forward to SMHCA being named FMHCA's "Chapter of the Year" for the third year running. &nbsp;Feel free to contact me with your ideas on how to make that happen. &nbsp;Cheers!</span>Aaron Norton, LMHC, LMFThttp://www.blogger.com/profile/00635484623173913946noreply@blogger.com2tag:blogger.com,1999:blog-2321285534867921261.post-67918446343732299732013-12-27T19:07:00.001-08:002013-12-27T19:07:41.290-08:00Exploring New Terrain: DSM-5 and Substance Use Disorders<div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"><em><span style="font-size: x-small;">This article re-posted from the<a href="http://myemail.constantcontact.com/FMHCA-Newsletter-November-2013.html?soid=1106162505063&amp;aid=69-mRW84FMI" target="_blank"> Florida Mental Health Counselors Association November 2013 newsletter</a></span><b><a href="http://myemail.constantcontact.com/FMHCA-Newsletter-November-2013.html?soid=1106162505063&amp;aid=69-mRW84FMI" target="_blank"> </a></b></em></span></div><div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"><em><b>&nbsp;</b></em></span></div><div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"><em><b>Explore DSM-5 at the 2014 FMHCA Annual Conference</b></em></span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"> </span><div><span style="color: black; font-family: Arial,Helvetica,sans-serif; font-size: 10pt;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="color: #989898;"><em>by Aaron Norton, LMHC, CAP, CRC</em></span><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"> &nbsp; &nbsp;</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><br /></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">It's been six months since the release of the fifth edition of the </span><i>Diagnostic and Statistical Manual of Mental Disorders</i><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"> (DSM-5), and counselors are gradually shifting towards full implementation of the new criteria. For many, this task is overwhelming and perhaps unwelcome.</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><br /></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">After all, human beings are in many ways creatures of habit, and counselors are no exception. It takes a great deal of time and effort to re-educate ourselves every time the "bible of psychiatry" written in dry, academic prose gets tampered with, and if you're like me, you're pretty busy and can think of much more interesting things to do with your limited spare time. Personally, the best way I could think of to force myself to learn about the DSM-5 was to register for a number of trainings and start scheduling my own presentations on the topic, paying homage to the old saying, "We teach what we need to learn" (or is it, "Those who can't, teach?").</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><br /></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">Still, this nearly 1,000 page snoozer offers us far more utility than bibliotherapeutic treatment of insomnia via bedtime reading, filling an empty space on our office bookshelves, or serving effectively as an expensive paper weight. The DSM-5, as imperfect as it may be, is the "gold standard" of diagnosis and case formulation here in the U.S. It helps us organize our thoughts, identify effective treatments, and measure clinical progress. Knowledge of its contents is required of counseling students in CACREP-accredited programs, interns sitting for their licensure exams, and clinicians who work with third party payers who want to ensure that we're submitting claims for treatment of a disorder vs. preventative care. In this professional climate, updating ourselves on DSM revisions is a matter of </span><i>necessity</i><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">, not luxury.</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><br /></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">FMHCA is doing its part in helping counselors accomplish this daunting task by providing a two-day conference this February dedicated to updating counselors on a variety of changes impacting our field. By my count, the conference includes nearly nine hours of DSM-5 update training, including my three hour workshop on using the DSM-5 and the newly released 2013 American Society of Addiction Medicine (ASAM) treatment criteria to conduct quality substance abuse assessment and evaluation. I'm hoping to make the DSM-5 update easier by focusing on the paradigm shift in the new edition and connecting each change to that shift.</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><br /></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">What do I mean by "paradigm shift?" Let's start with a brief glimpse of the history of the DSM. The first edition, published in 1952, was dramatically brief in comparison to the heavy volume we're now so familiar with. It consisted of brief, psychodynamic-oriented descriptions of disorders. The next paradigm shift of the DSM came with the third edition published in 1980, which implemented a medical model with very specific criteria for disorders and a litany of statistical data supporting each. Not surprisingly, the DSM expanded dramatically in length with that edition.</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><br /></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">The DSM-5 was intended to establish a new paradigm shift within the context of the existing medical model of diagnosis. As I see it, the six most salient examples of this shift include efforts to:</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><br /></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><ol><li style="margin-bottom: 0px; margin-top: 0px;"><span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">&nbsp;</span>Reduce the dichotomous nature of diagnosis (i.e. "You either have the disorder, or you don't") by shifting towards a spectrum approach to classifying disorders with more specific information attached to the diagnosis (e.g. more specifiers available for each diagnosis, including extra scales of severity);</li><li>Streamline and simplify diagnosis by combing similar disorders and then providing more options within the diagnosis in the form of new specifiers. (You'll be happy to know, by the way, that for the first time in DSM history, the volume actually <i>decreased </i>in size.);</li><li>De-pathologize "different" by more clearly delineating between <i>abnormal</i> and <i>disordered</i> human experience;</li><li style="margin-bottom: 0px; margin-top: 0px;"><span>&nbsp;</span>Reduce the frequency of inaccurate or generic diagnosis;</li><li>Enhance consideration of cultural and developmental factors in the diagnostic process; and</li><li>Eliminate the phenomenon of "mind-body dualism" inherent in previous editions. It's official; the large group of psychiatric professionals tasked with developing the new edition have decided that our brains are, in fact, part of our bodies. Consequentially, it no longer makes sense to separate the physical aspects of human wellness from the mental aspects of wellness as though the two are entirely separate realms with no overlap.</li></ol><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">&nbsp;&nbsp;</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">Changes made to substance use and related disorders provide an excellent example of all of these paradigm shifts:</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><ol><li style="margin-bottom: 0px; margin-top: 0px;"><b>Streamline and simplify diagnosis and reduce the dichotomous nature of diagnosis:</b> Because the DSM-IV diagnoses of Substance Abuse and Substance Dependence differed primarily in severity, the two disorders have been collapsed into one substance use disorder with an added spectrum of severity in the form of mild, moderate, and severe specifiers based on the number of symptoms the client meets. This measure also solves the problem of "diagnostic orphans," a concept a little too complex to address in this article (although it will be covered at FMHCA's annual conference). It also eliminates the DSM-IV problem of the absence of a diagnosis for Nicotine Abuse. Previously, only Nicotine Dependence could be diagnosed, but in the DSM-5 a milder tobacco use disorder is available. The symptoms have also been reordered into groups that may make more sense to the clinican.</li><li style="margin-bottom: 0px; margin-top: 0px;"><b>De-pathologize:</b> The more loaded terms "abuse and dependence" have been replaced with the more neutral phrase "substance use disorder." Also, the threshold for the number of symptoms needed for a diagnosis has increased from one to two to strengthen the legitimacy of the diagnosis.</li><li style="margin-bottom: 0px; margin-top: 0px;"><span>&nbsp;</span><b>Reduce the phenomenon of inaccurate or generic diagnosis:</b> The diagnosis Polysubstance Dependence has been deleted, because it was so frequently inaccurately applied by clinicians. For the first time, craving (a strong desire or urge to use) has been added to the diagnostic criteria;</li><li style="margin-bottom: 0px; margin-top: 0px;"><b>Increase cultural and developmental sensitivity in the diagnostic process</b>: The symptom for recurrent problems with law enforcement was eliminated "<a href="http://www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact%20Sheet.pdf" rel="nofollow" shape="rect" style="color: #49b3ff; text-decoration: underline;" target="_blank">because of cultural considerations that make the criteria difficult to apply internationally</a><span style="line-height: 115%;">" and many of the statistics on substance use disorders provide detail on differences among age groups;</span></li><li style="margin-bottom: 0px; margin-top: 0px;"><b>Eliminate mind-body dualism: </b>The specifiers "with physiological dependence" and "without physiological dependence" have been removed. Frankly speaking, the delineation between physical and psychological addiction is silly. Cannabis Withdrawal has been added as a diagnosis based on decades of consistent research and case history of a clear withdrawal syndrome experienced by many chronic, daily marijuana users. This addition contradicts the popular societal myth that marijuana isn't<i> physically</i> addictive; it's just <i>psychologically</i> addictive. Caffeine Withdrawal has also been added, although Caffeine Use Disorder exists only in Section III of the DSM-5 to be considered for future revisions.</li></ol><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><br /></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">As helpful as I view some of these changes, the new criteria raise a few interesting dilemmas for counselors to ponder.</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><br /></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">For example, the Americans with Disabilities Act and the Rehabilitation Act acknowledge that Alcoholism and drug addiction (or "chemical dependency" as some government programs label it) can be protected disabilities, provided that other requirements for a disorder to be considered a disability are met and the individual is no longer using the substance. Traditionally, a DSM-IV diagnosis of Substance Abuse was not sufficient to be considered a disability, whereas Substance Dependence may be. Moreover, Substance Abuse could be considered a temporary diagnosis, whereas Substance Dependence was considered a chronic disorder, regardless of whether or not it was in remission. How will rehabilitation counselors, diagnosticians employed by social programs, and others involved in social program eligibility now delineate between abuse and dependence?</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><br /></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">And now that the criterion for "recurrent substance-related legal problems" has been removed, how will diagnosticians be able to determine if a defensive client with a significant history of substance-related arrests still meets criteria for a substance use disorder based on the remaining criteria?</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><br /></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">And now that the DSM criteria for substance use disorders has changed, what will change with ASAM treatment criteria?</span></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><br /></div><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;"></span><div style="font-style: normal; font-weight: normal; margin-bottom: 0px; margin-top: 0px; text-align: left;"><span style="font-family: &quot;Helvetica Neue&quot;,Arial,Helvetica,sans-serif;">As much as I want to be helpful with this article, I'm not going to give away the farm, folks. I'll be happy to answer explore these issues in detail at FMHCA's annual conference in February. I hope to see you there!</span></div></span></div>Aaron Norton, LMHC, LMFThttp://www.blogger.com/profile/00635484623173913946noreply@blogger.com2tag:blogger.com,1999:blog-2321285534867921261.post-56653674493469865532013-06-02T17:21:00.000-07:002013-06-02T17:22:40.169-07:00Reflections on DSM-5: Strengths and Controversies<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-PgUtcvMulNI/Uau-JN79mSI/AAAAAAAAAHE/I2DlNeFEDIA/s1600/DSM5.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://2.bp.blogspot.com/-PgUtcvMulNI/Uau-JN79mSI/AAAAAAAAAHE/I2DlNeFEDIA/s1600/DSM5.jpg" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The DSM-5 is a tool used by mental health professionals for case conseputalization</td></tr></tbody></table><span style="font-family: Verdana,sans-serif;">A couple weeks ago, the <a href="http://www.apa.org/" target="_blank">American Psychiatric Association</a> (APA) unveiled the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), triggering headlines such as "<a href="http://www.foxnews.com/health/2013/05/21/dsm-5-is-here-what-controversial-new-changes-mean-for-mental-health-care/" target="_blank">DSM-5 is here: What the controversial new changes mean for mental health care</a>" and "<a href="http://www.cbsnews.com/8301-204_162-57585129/controversial-update-to-psychiatry-manual-dsm-5-arrives/" target="_blank">Controversial update to psychiatry manual, DSM-5, arrives</a>."</span><br /><br /><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody><tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-FM_8y57wi5w/Uavf2n_QbzI/AAAAAAAAAHs/EyxGqpmzsiE/s1600/Presentation1.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="151" src="http://3.bp.blogspot.com/-FM_8y57wi5w/Uavf2n_QbzI/AAAAAAAAAHs/EyxGqpmzsiE/s200/Presentation1.JPG" width="200" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Aaron Norton, LMHC, presents on DSM-5</td></tr></tbody></table><span style="font-family: Verdana, sans-serif;">The buzz word, of course, is "controversy."&nbsp; And why not?&nbsp; Few, if any, areas of modern medicine are more controversial than Psychiatry.&nbsp; Mental illness remains, in many respects, stigmatized by society-at-large.&nbsp; Many struggle to accept mental disorders as legitimate medical conditions.&nbsp; Throw in the fact that although the DSM was created to aid trained mental health professionals with case conceptualization for treatment planning, others use it to build a case for or against someone in criminal and civil case proceedings, disability determination, and eligibility for a number of social programs.&nbsp;</span><br /><br /><span style="font-family: Verdana, sans-serif;">The stakes are high and the implications are vast, so any changes in the way mental health professionals categorize, label, or conceptualize mental disorders are bound to be met with some degree of skepticism or criticism both within and outside the field.&nbsp; I think that's just par for the course.</span><br /><br /><span style="font-family: Verdana, sans-serif;">But what are the hot button issues with this revision?&nbsp; What are critics alleging?&nbsp; I'll briefly explore two of the most commonly discussed controversies:</span><br /><br /><span style="font-family: Verdana, sans-serif;">1) <b>The creation of new disorders pathologizes normal human behaviors and experiences.&nbsp;</b> <a href="http://www.dsm5.org/Documents/Disruptive%20Mood%20Dysregulation%20Disorder%20Fact%20Sheet.pdf" target="_blank">Disruptive Mood Dysregulation Disorder</a>, <a href="http://psychcentral.com/lib/2012/what-you-need-to-know-about-premenstrual-dysphoric-disorder/" target="_blank">Premenstrual Dysphoric Disorder</a>, <a href="http://www.dsm5.org/Documents/Mild%20Neurocognitive%20Disorder%20Fact%20Sheet.pdf" target="_blank">Mild Neurocognitive Disorder</a>, and <a href="http://www.dsm5.org/Documents/Eating%20Disorders%20Fact%20Sheet.pdf" target="_blank">Binge Eating Disorder</a> are among the most controversial additions, and the removal of the <a href="http://www.dsm5.org/Documents/Bereavement%20Exclusion%20Fact%20Sheet.pdf" target="_blank">Bereavement exclusion</a> from the criteria for a Major Depressive episode has triggered criticism that <a href="http://www.huffingtonpost.com/jeanne-dennis/grief-depression-dsm_b_3306490.html" target="_blank">normal human grief has been unnecessarily labeled a disorder</a>.&nbsp; I think this is a valid concern in the sense that I am attuned to the risk of medicalizing unpleasant or abnormal human experience.&nbsp; But when I read the criteria for these new disorders, it seemed obvious to me that the new edition isn't targeting common temper tantrums, <span style="font-size: small;">the occasional fast food drive thru experience</span>, mild absentmindedness, or the typical mood fluctuation that many women experience during "that time of the month."&nbsp; I think the criteria paint a fairly clear picture of a severe symptom presentation causing a clinically significant degree of impairment or distress that often warrants treatment.&nbsp; And because I recognize that the neurobiology of a clinically depressed person isn't different if that individual is grieving the loss of a loved one, removal of the Bereavement exclusion makes logical sense to me.&nbsp; Moreover, there are several examples in the DSM-5 of the de-stigmatization of abnormal human experiences.&nbsp; Changes in the category of <a href="http://www.dsm5.org/Documents/Paraphilic%20Disorders%20Fact%20Sheet.pdf" target="_blank">Paraphilic Disorders</a> and the re-classification of <a href="http://www.dsm5.org/Documents/Gender%20Dysphoria%20Fact%20Sheet.pdf" target="_blank">Gender Dysphoria</a> are, I think, great examples.&nbsp; Of course, the DSM is essentially the brainchild of the APA, an association that exclusively represents psychiatrists vs. mental health professionals who treat mental illness without prescribing medication (e.g. counselors, therapists, psychologists, clinical social workers), so <a href="http://vitals.nbcnews.com/_news/2013/05/17/18304522-chorus-of-critics-greets-new-psychiatric-manual-release?lite" target="_blank">some are concerned that the APA is in bed with "Big Pharma</a>," and therefore benefits from classifying relatively benign human experiences as a form of mental illness.&nbsp; Meanwhile, while some believe that the DSM-5 revisions will cause an increase in the number of Americans who are deemed "mentally ill," others are concerned that revisions will squeeze some Americans out of diagnostic labels.&nbsp; For example, some critics of the merger of Aperger's Disorder into Autism Spectrum Disorder <a href="http://www.abc.net.au/rampup/articles/2013/05/24/3766915.htm" target="_blank">fear that some individuals currently diagnosed with Asperger's won't meet the new diagnostic criteria</a> despite the <a href="http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf" target="_blank">APA's findings to the contrary</a>.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">2) <b>The classification system is arbitrary and/or not organized based on the neurobiological characteristics of the disorder.&nbsp; </b>Just prior to the release of the DSM-5, Dr. Thomas Insel, the Director of the National Institutes of Mental Health, alleged that "</span><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure," opining that "<a href="http://www.psychologytoday.com/blog/side-effects/201305/the-nimh-withdraws-support-dsm-5" target="_blank">patients with mental disorders deserve better</a>."&nbsp; I certainly agree </span></span><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;"><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody><tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-_KccYsd-AfE/UavfY27ac1I/AAAAAAAAAHc/j2rUzabMGLM/s1600/dr-insel-2011.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="http://4.bp.blogspot.com/-_KccYsd-AfE/UavfY27ac1I/AAAAAAAAAHc/j2rUzabMGLM/s200/dr-insel-2011.jpg" width="132" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><u>Thomas Insel, MD</u></td></tr></tbody></table></span></span><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;">that the DSM's classification system is not ideal, but I also believe that mental health is a complex subject area; it can't necessarily be reduced to a set of data points extrapolated from a routine lab test.&nbsp; As we continue to develop new technologies for study of the human brain, I imagine the way we classify mental disorders will continue to evolve.&nbsp; Indeed, there are several examples of changes in the DSM-5 that stem from advancements in the field of Neuroscience.&nbsp; Gambling Disorder shifted into the new <a href="http://www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact%20Sheet.pdf" target="_blank">Substance Use and Addictive Disorders </a>chapter due to commonalities in the underlying neurobiology of both addictive experiences.&nbsp; <a href="http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf" target="_blank">Asperger's Disorder was merged in with Autism and two other developmental disorders</a> based on evidence that the four disorders were, on a biological level, varying degrees of severity of the same disorder.&nbsp; The DSM-IVTR chapter entitled "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence" was eliminated, and disorders previously listed in that chapter were reorganized into chapters of disorders with similar underlying neurobiological processes.&nbsp; Lastly, I'm not certain that any critics of the current classification system have any better ideas at the present.&nbsp; Two weeks after posting his criticisms of the DSM-5, Insel co-wrote a <a href="http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdoc-shared-interests.shtml" target="_blank">press release</a> conceding that "Today, the American Psychiatric Association's (APA) Diagnostic and Statistical</span></span><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"> Manual of Mental Disorders (DSM), along with the International Classification of Diseases (ICD) represents the best information currently available for clinical diagnosis of mental disorders."</span></span><br /><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">So what do I like about the DSM-5?&nbsp; I like that several revisions reinforce the notion that the distinction between the body and brain are, essentially, more myth than fact.&nbsp; People often think of mental health as a distinctively separate realm from physical health, as though the two were entirely disconnected spheres of the human experience.&nbsp; But what are mental disorders if not biological?&nbsp; They involve genetics, neurotransmitters and hormone levels, brain structures, electrical impulses that travel through the body, encoding of information into short-term and long-term memory, organization of various mental constructs imprinted through life experience, and the intriguing interface between environmental exposure and internal biology (e.g. <a href="http://learn.genetics.utah.edu/content/epigenetics/" target="_blank">epigenetics</a>).&nbsp; Even "non-medical" treatments such as psychotherapy are, in essence, biological interventions in the sense that they involve refined integration of the brain and trigger neurological processes such as <a href="http://www.medterms.com/script/main/art.asp?articlekey=40362" target="_blank">neuroplasticity</a> and <a href="http://www.news-medical.net/health/Neurogenesis-What-is-Neurogenesis.aspx" target="_blank">neurogenesis</a>.&nbsp; The field of <a href="http://en.wikipedia.org/wiki/Psychoneuroimmunology" target="_blank">psychoneuroimmunology</a> is bursting with findings substantiating the connection between Mind and Body.&nbsp; Consequentially, I'm pleased with subtle verbiage changes such as scrapping the phrase "due to a general medical condition" for a more accurate word choice of "due to another medical condition."&nbsp; And I'm thrilled that <a href="http://www.dsm5.org/Documents/Somatic%20Symptom%20Disorder%20Fact%20Sheet.pdf" target="_blank">somatic disorders can now be diagnosed even if an individual has a known, legitimate, diagnosed medical condition</a>.</span></span><br /><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">I also like that the classification system is less dichotomous.&nbsp; Several disorders have been merged together and <a href="http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/DSM-5-Integrated-Approach.pdf" target="_blank">conceptualized as varying points on a spectrum</a>.&nbsp; The truth is that two people with the same diagnosis can experience dramatically different levels of severity and functioning.&nbsp;&nbsp;</span></span><br /><br /><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Finally, the DSM-5 is overall a somewhat more simplified and streamlined product than the DSM-IVTR.&nbsp; Its shorter in length with several examples of less convoluted wording.&nbsp; Some old diagnostic labels that have become pejorative labels have been renamed (e.g. "Mental Retardation" became "<a href="http://www.dsm5.org/Documents/Intellectual%20Disability%20Fact%20Sheet.pdf" target="_blank">Intellectual Disability</a>"). </span></span><br /><br /><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">All in all, I think the DSM-5 is an improved product in comparison to the DSM-IVTR. Its imperfect and flawed, like any organizational system, but it's probably the best that we have for now.&nbsp; We'll see what changes with future revisions. </span></span><br /><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Resources:&nbsp;</span></span><br /><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><a href="http://www.psych.uic.edu/docassist/changes-from-dsm-iv-tr--to-dsm-51.pdf" target="_blank">Highlights of Changes from DSM-IVTR to DSM-5</a></span></span><br /><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><a href="http://www.dsm5.org/Pages/Default.aspx" target="_blank">APA's DSM-5 website</a></span></span><br /><br /><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Want to learn more about DSM-5 revisions?&nbsp; If your agency or practice would benefit from an-service training, <a href="http://www.anorton.com/ContactMe.en.html" target="_blank">ask me</a> about <a href="http://www.anorton.com/userfiles/688392/file/DSM-5%20Update.pdf" target="_blank">my presentation on DSM-5</a>.&nbsp; I'm available for workshops, conferences, and in-service training in the Tampa Bay area.</span></span><br /><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-vc7l_UgCGn0/Uavb5A095hI/AAAAAAAAAHQ/LAepIc5Ph9s/s1600/Presentation3.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="133" src="http://1.bp.blogspot.com/-vc7l_UgCGn0/Uavb5A095hI/AAAAAAAAAHQ/LAepIc5Ph9s/s320/Presentation3.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Aaron Norton, LMHC provides training on DSM-5</td></tr></tbody></table><br /><br /><br /><br /><br />Aaron Norton, LMHC, LMFThttp://www.blogger.com/profile/00635484623173913946noreply@blogger.com1tag:blogger.com,1999:blog-2321285534867921261.post-72024933379155100312012-12-16T13:54:00.001-08:002012-12-20T13:39:25.170-08:00Conservatives, Liberals, & Libertarians: How We Reason and How We Relate<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-h1mXnFp9Hng/UM4OpNON3nI/AAAAAAAAAE8/ZPj8uzKOevs/s1600/RvsD.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="197" src="http://2.bp.blogspot.com/-h1mXnFp9Hng/UM4OpNON3nI/AAAAAAAAAE8/ZPj8uzKOevs/s320/RvsD.jpg" width="320" /></a></div><br /><br /><br /><br /><br /><span style="font-family: Verdana, sans-serif;">Last month, during the second week of November, several of my clients mentioned the election results during their sessions.&nbsp; Some felt optimistic and jubilant about the results; others were anxious, depressed, disheartened, or frustrated.&nbsp; Some shared mixed feelings and ambivalent thoughts; still others were indifferent to the entire process.&nbsp; Because I'm blessed to have friends with a wide and diverse range of political beliefs, my Facebook page news feed was packed with thoughtful and sometimes divisive commentary leading up to Election Day, as I imagined yours probably was.&nbsp;&nbsp;</span><br /><br /><span style="font-family: Verdana, sans-serif;">When the dust started to settle, I thought it would be good timing to post a synopsis of research I've been reading on the moral and psychological differences and similarities between conservatives and liberals.&nbsp; Because my interpretation of the data I reviewed led me to a conclusion that virtually all Americans who are passionate about politics embed their beliefs in sound and perhaps commendable moral principles, it was my hope that with the holiday season, the information I posted might save a few families from some heated holiday dinner arguments.</span><br /><br /><span style="font-family: Verdana, sans-serif;">But just as I was about to post this information, tragedy ensued.&nbsp; Two days ago, <a href="http://www.foxnews.com/us/2012/12/16/at-least-26-dead-in-shooting-at-connecticut-school/" target="_blank">20-year-old Adam Lanza used two nine millimeter handguns to murder 26 people at Sandy Hook Elementary School in Newton, Connecticut</a>, including 20 children between six and 10 years of age.&nbsp; Instantly, my Facebook news feed was centered on the tragedy.&nbsp; While the majority of the posts I read expressed grief, empathy, and compassion for the victims, I noticed an instant slew of political commentary on the event from others who are passionate about their political beliefs.&nbsp;&nbsp; </span><br /><br /><span style="font-family: Verdana, sans-serif;">On the Left, I read comments like these:</span><br /><br /><ul><a href="http://3.bp.blogspot.com/-6wI7C7_-NZs/UM5A-ef2btI/AAAAAAAAAGE/oCnYUKhZRdE/s1600/Connecticut_School_Shooting_Hub_Generic_640x480_20121214140106_640_480.PNG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="http://3.bp.blogspot.com/-6wI7C7_-NZs/UM5A-ef2btI/AAAAAAAAAGE/oCnYUKhZRdE/s200/Connecticut_School_Shooting_Hub_Generic_640x480_20121214140106_640_480.PNG" width="200" /></a><li><span style="font-family: Verdana, sans-serif;">"<span class="userContent">Obama please rid this country of conservative 'values' 20 kids died today in part because of those values."</span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent">"<span class="userContent">So this tragedy has once again shown that Americans cling to their guns and religion...Somehow I'm sure our founding fathers and Jesus would be saying you guys got it all wrong"</span></span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent"><span class="userContent">"<span class="userContent">How many mass shootings must this country endure before something is done about gun control on the Federal level?"</span></span></span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent"><span class="userContent"><span class="userContent">&nbsp;<span class="userContent">"And people don't want tougher gun laws...so sad"</span></span></span></span></span></li></ul><br /><span style="font-family: Verdana, sans-serif;">&nbsp;Here's a sample of some of the commentary from friends on the Right:</span><br /><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody><tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-P2FADFlKXXg/UM5CSe3XblI/AAAAAAAAAGM/GkRSbRm9RPo/s1600/connecticut-school-shooting.jpeg1-1280x960.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="150" src="http://1.bp.blogspot.com/-P2FADFlKXXg/UM5CSe3XblI/AAAAAAAAAGM/GkRSbRm9RPo/s200/connecticut-school-shooting.jpeg1-1280x960.jpg" width="200" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span class="caption"><span style="font-family: Verdana,sans-serif;">St. John's Episcopal Church, near the scene of the shooting</span> </span></td></tr></tbody></table><ul><li><span style="font-family: Verdana, sans-serif;">&nbsp;"<span class="userContent">People wonder where God was during this tragedy and blame Him for these unimaginable losses, but yet we are becoming a Godless nation. Why am I not shocked?"</span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent">"If more teachers were armed, maybe this tragedy wouldn't have happened."</span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent">"<span class="userContent">Respond in weeping with those who weep, respond in prayer, respond by searching your own heart, respond in repentance and respond in love." </span></span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent">I read several posts featuring news stories and video footage of criminals who were using guns or other weapons to harm people being thwarted by armed citizens who used guns to defend innocent lives.</span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent">"At the gun range...my second amendment rights shall NOT be infringed upon."</span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent">"...<span data-ft="{&quot;tn&quot;:&quot;K&quot;}" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0.[0]">I think the media plays a huge role...bigger than anything else! You would not have seen this 50 years ago...even 20 years ago."</span></span></span></span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent"><span data-ft="{&quot;tn&quot;:&quot;K&quot;}" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0.[0]">&nbsp;<span data-ft="{&quot;tn&quot;:&quot;K&quot;}" id=".reactRoot[19].[1][2][1]{comment4621390167155_4989238}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[19].[1][2][1]{comment4621390167155_4989238}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4989238}.0.[1].0.[1].0.[0].[0][2].0.[3]"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4989238}.0.[1].0.[1].0.[0].[0][2].0.[3].0"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4989238}.0.[1].0.[1].0.[0].[0][2].0.[3].0.[0]">"When tragedy strikes, understand that a blanket anti-gun perspective also prevents many Americans from defending themselves and their loved ones."</span></span></span></span></span></span></span></span></span></span></li></ul><br /><span style="font-family: Verdana, sans-serif;">Depending on your own political and religious beliefs, some of these comments may offend you while you may experience as reasonable responses to a tragedy that evokes strong aversive emotions within most people.&nbsp; (All this is aside from the issue of whether or not it was appropriate timing to politicize a tragedy of national interest.)&nbsp; I think these quotes illustrate the following about people on both sides of the aisle: (1) We care about tragedy and suffering; (2) We sometimes convert our hurt and anxiety into anger, searching for one or more scapegoats; (3) We sometimes demonize "the other side" rather than seek to understand them even if we disagree with them.</span><br /><br /><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody><tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-vmH3C9I5RSk/UM48BK1XfHI/AAAAAAAAAFk/Dd-m-GH3Ynw/s1600/Jon_Haidt2_SM.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="http://3.bp.blogspot.com/-vmH3C9I5RSk/UM48BK1XfHI/AAAAAAAAAFk/Dd-m-GH3Ynw/s1600/Jon_Haidt2_SM.jpg" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Verdana,sans-serif;">Jonathan Haidt, PhD</span></td></tr></tbody></table><span style="font-family: Verdana, sans-serif;"><span class="userContent"><span data-ft="{&quot;tn&quot;:&quot;K&quot;}" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0.[0]">Social psychologist, professor, and University of Virginia researcher (and this year's <a href="http://www.amhca.org/member/annual_conference.aspx" target="_blank">keynote speaker</a> at the annual conference of the American Mental Health Counselors Association) <a href="http://people.virginia.edu/~jdh6n/" target="_blank">Jonthan Haidt</a>, who has been described as "the world's leading expert on the science of morality," sought to better understand the moral psychology of conservatives and liberals through the lens of <a href="http://www.moralfoundations.org/" target="_blank">moral foundations theory</a>, a pluralist moral theory that proposes that human moral reasoning can be divided into six foundations that evolved in human beings concurrent with the development of civilization:</span></span></span></span></span><br /><ol><li><span style="font-family: Verdana, sans-serif;"><span class="userContent"><span data-ft="{&quot;tn&quot;:&quot;K&quot;}" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0.[0]"><b>Care/Harm:</b> Virtues of kindness, gentleness, and nurturance fostered by our ability to feel and dislike the pain of others;</span></span></span></span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent"><span data-ft="{&quot;tn&quot;:&quot;K&quot;}" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0.[0]"><b>Fairness/Cheating:</b> Virtues of justice, rights, autonomy that can be further divided into two types of fairness; equality and proportionality;</span></span></span></span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent"><span data-ft="{&quot;tn&quot;:&quot;K&quot;}" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0.[0]"><b>Liberty/Oppression:</b> Characterized by feelings of reactance and resentment people feel towards those who dominate them and restrict their liberty; a contempt for "bullies" and oppressors;</span></span></span></span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent"><span data-ft="{&quot;tn&quot;:&quot;K&quot;}" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0.[0]"><b>Loyalty/Betrayal:</b> Virtues of patriotism and self-sacrifice for the group;</span></span></span></span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent"><span data-ft="{&quot;tn&quot;:&quot;K&quot;}" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0.[0]"><b>Authority/Subversion:</b> Virtues of leadership and followership, including respect of legitimate authority and traditions;</span></span></span></span></span></li><li><span style="font-family: Verdana, sans-serif;"><span class="userContent"><span data-ft="{&quot;tn&quot;:&quot;K&quot;}" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0.[0]"><b>Sanctity/Degradation:</b> Reflective of the idea that the body is a temple that should not be desecrated by immoral activities or contaminants.&nbsp;</span></span></span><span data-ft="{&quot;tn&quot;:&quot;K&quot;}" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2]"><span class="UFICommentBody" id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0"><span id=".reactRoot[19].[1][2][1]{comment4621390167155_4988932}.0.[1].0.[1].0.[0].[0][2].0.[0]"> </span></span></span></span></span></li></ol><span style="font-family: Verdana, sans-serif;">Both liberals and conservatives are often thoroughly convinced that their beliefs are the "right," "moral" or "superior" ethical beliefs, but what did Haidt and other researchers find out about the differences in how liberals and conservatives engaged in moral reasoning when they administered the <a href="http://www.google.com/url?sa=t&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=1&amp;ved=0CDwQFjAA&amp;url=http%3A%2F%2Fwww.moralfoundations.org%2FMFQ30.self-scorable.doc&amp;ei=hSjOUNfkB5G89QSomoHACA&amp;usg=AFQjCNFvqaItSJTGfSgP_cUuIDb8AIyRmQ&amp;sig2=rM9B7BzYJvH_eeLkJfGkGg&amp;bvm=bv.1355325884,d.eWU&amp;cad=rja" target="_blank">Moral Foundations Questionnaire</a>?</span><br /><br /><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody><tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-nPAa5rlQjlI/UM4-Y_vjxFI/AAAAAAAAAF8/tl2AxPHdLi0/s1600/ABrooks-customerphoto07.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="http://4.bp.blogspot.com/-nPAa5rlQjlI/UM4-Y_vjxFI/AAAAAAAAAF8/tl2AxPHdLi0/s200/ABrooks-customerphoto07.jpg" width="146" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Verdana,sans-serif;">Arthur Brooks, PhD</span></td></tr></tbody></table><ol><li><span style="font-family: Verdana, sans-serif;"><b>Liberals emphasize the Care foundation above all other moral precepts.&nbsp; Conservatives also highly value this foundation, although slightly less than liberals.</b>&nbsp; However, conservative caring is somewhat different-it tends to be less focused on animals or people in other countries and more focused on sacrifice for the group (e.g. care for wounded veterans);</span></li><li><span style="font-family: Verdana, sans-serif;"><b>Both liberals and conservatives care about the Fairness foundation, but there are two kinds of fairness: (1) Equality (favored by liberals); and (2) Proportionality, meaning that people are rewarded in proportion to what they contribute (favored by conservatives).</b>&nbsp; Social scientist <a href="http://www.aei.org/scholar/arthur-c-brooks/" target="_blank">Arthur Brooks</a> applies these concepts in economic terms by labeling them as (1) Redistributive fairness: It is fair to equalize rewards, whereas inequality is inherently unfair (favored by liberals); and (2) Meritocratic fairness: Fairness means matching reward to merit, whereas forced equality is inherently unfair.&nbsp; In other words, liberals tend to prefer that people have similar incomes even if they may be contributing to society in varying degrees, whereas conservatives accept the notion of different incomes based on what people are contributing to society, the economy, the company, etc.&nbsp; </span></li><li><span style="font-family: Verdana, sans-serif;"><b>Conservatives are more likely to emphasize the Loyalty, Authority, and Sanctity foundations than liberals. </b>The Liberal emphasis on the Care Foundation results in a tendency towards universalism and away from nationalism and puts them in opposition to hierarchy, inequality, and power.&nbsp; Liberals who consider themselves spiritual, however, tend to join conservatives in emphasizing the Sanctity foundation, although in different forms.&nbsp; For example, spiritual liberals are more likely to visit New Age grocery stores, where they'll find a variety of products that promise to "cleanse" them of "toxins," whereas religious conservatives are more likely to refer to the "sanctity" of life, marriage, the family, etc.&nbsp; Religious conservatives are more likely, in Haidt's words, to "view the body as a temple, housing a soul within, rather than as a machine to be optimized, or as a playground to be used for fun."</span></li><li><span style="font-family: Verdana, sans-serif;"><b>The Liberty foundation is, essentially, owned by libertarians, a third political group that doesn't fit neatly into the conservative or liberal camps</b> (although they are more likely to vote for Republican or third party candidates than for Democrats).&nbsp; Libertarians identify with the early American political ideology known as <a href="http://en.wikipedia.org/wiki/Classical_liberalism" target="_blank">classical liberalism</a>.&nbsp; Like contemporary American liberals, libertarians strongly emphasize civil liberties and take many "socially liberal" positions, such as support for gay marriage and the legalization of "victimless crimes," such as adult pornography, prostitution, and recreational drug use, regardless of whether they view those acts as healthy or moral.&nbsp; </span><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;">They differ from the "<a href="http://en.wikipedia.org/wiki/Christian_right" target="_blank">Religious Right</a>" faction of conservatives in the sense that they are more likely to be atheists or agnostics (although many prominent libertarian politicians are Christians) who abhor the use of government as a tool for imposing one's personal religious beliefs onto the public-at-large.&nbsp; </span>But like conservatives, libertarians prefer a nation with a very limited, fiscally conservative government, lower taxes, and a free market with minimal government interference.</span></li><div style="text-align: right;"></div><li><span style="font-family: Verdana, sans-serif;"><b>Liberals are more likely to inaccurately stereotype the moral reasoning of conservatives than vice versa.</b>&nbsp; Haidt teamed up with two other researchers, Jesse Graham and Brian Nosek, to conduct <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050092" target="_blank">an experiment with more than 2,000 American participants</a> in which one-third of the time participants were asked to fill out the Moral Foundations Questionnaire normally, answering only as themselves.&nbsp; For the other two-thirds of the time, they were asked to complete the questionnaires as they think a "typical liberal" or "typical conservative" would respond, allowing researchers to examine stereotypes that each side held about the other.&nbsp; The more liberal a respondent, the more likely he or she was to inaccurately stereotype the other side.&nbsp; According to Haidt, "The biggest errors in the whole study came when liberals answered the Care and Fairness question while pretending to be conservatives."&nbsp; (<a href="http://faculty.virginia.edu/haidtlab/articles/manuscripts/graham.nosek.submitted.moral-stereotypes-of-libs-and-cons.pub601.pdf" target="_blank">Read more about this experiment</a>.)&nbsp; <span style="font-family: Verdana, sans-serif;">Some of my liberal friends have accused conservatives (and libertarians) of being selfish, greedy people who only care about themselves, but in Haidt's words, "</span><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;">Everyone-left, right, and center-says that concerns about compassion, cruelty, fairness, and injustice are relevant to their judgments about right and wrong."</span>&nbsp; While it's true that liberals score slightly higher on empathy than conservatives, the myth of conservative selfishness is contradicted by their scores on the Care and Fairness foundations and by a series of studies suggesting that while liberals are more likely to rely on government as a means for caring for the needy, <a href="http://www.nytimes.com/2008/12/21/opinion/21kristof.html?_r=0" target="_blank">conservatives are more likely to care for the needy through personal charity (especially religious conservatives), and more likely to volunteer for charitable purposes</a>. In other words, both liberals and conservatives care about the needy; they simply disagree on the means by which we can best provide that care.</span></span></li></ol><span style="font-family: Verdana, sans-serif;"><b>In sum, liberals tend to favor the Care foundation above all other moral foundations, libertarians tend to favor the Liberty foundation above all others, and conservatives tend to emphasize all five moral foundations</b>, as depicted in the graphs below:</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-xVU2iyNTmVs/UM4pk7qneSI/AAAAAAAAAFM/IXxHLuklwdM/s1600/HaidtChart.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="274" src="http://1.bp.blogspot.com/-xVU2iyNTmVs/UM4pk7qneSI/AAAAAAAAAFM/IXxHLuklwdM/s320/HaidtChart.jpg" width="320" /></a></div><span id="goog_1533717495"></span><span id="goog_1533717496"></span><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><br /></span><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-3SMcfFpR_L4/UM4qDeXCinI/AAAAAAAAAFU/YVTJoDWnBdM/s1600/libertarians-vs-liberals-conservatism-1024x840.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="262" src="http://2.bp.blogspot.com/-3SMcfFpR_L4/UM4qDeXCinI/AAAAAAAAAFU/YVTJoDWnBdM/s320/libertarians-vs-liberals-conservatism-1024x840.png" width="320" /></a></div><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">So now that we better understand the similarities and differences in moral reasoning of conservatives and liberals, <b>how can we have a healthier, more productive dialogue</b>?&nbsp; How can we avoid nasty arguments at family or social events or through online social networking sites like Facebook in which we say things we later regret?&nbsp;&nbsp;</span><br /><br /><span style="font-family: Verdana, sans-serif;">One option is to avoid discussing controversial subjects.&nbsp; While this approach works for some and may be effective at keeping the peace, it also prevents people from having healthy dialogue about important subjects and from learning more about others perspectives.&nbsp; It prevents us from obtaining new information that influences us to change our own positions, and sometimes these shifts are pivotal in increasing our life satisfaction.&nbsp;&nbsp;</span><br /><br /><span style="font-family: Verdana, sans-serif;">Perhaps this data gives us a starting point for a healthy dialogue about moral, religious, and political issues.&nbsp; In addition, I think these findings can be used to help increase empathy between people who lie on varying points of the political spectrum.</span><span style="font-family: Verdana, sans-serif;"><b>&nbsp; We can capitalize on the two &nbsp;moral foundations we all tend to share in common (Care and Fairness) rather than emphasizing the foundations we don't equally value.&nbsp; </b>Doing so can create a "launching pad" for a more constructive conversation about areas of disagreement.&nbsp;&nbsp;</span><br /><br /><span style="font-family: Verdana, sans-serif;"> I offer the following recommendations for a healthy political or religious dialogue:</span><br /><ol><li><span style="font-family: Verdana, sans-serif;"><b>Before you give your own perspective about a controversial issue, start by learning more about the other person's perspective.&nbsp;</b> Ask questions (e.g. "What do you want to be different?"&nbsp; "What are you concerned about?"&nbsp; "What about this is troubling to you?" "Why is this issue important to you?").</span></li><li><span style="font-family: Verdana, sans-serif;"><b>When you think you have a clearer picture of the other person's perspective, summarize your understanding of his or her perspective to check in and make sure you are understanding.</b>&nbsp; In relationship counseling, I often refer to this as "mirroring."&nbsp; If the other person does not think you are understanding, ask him or her to clarify and then continue mirroring until he or she agrees that you have it right.</span></li><li><span style="font-family: Verdana, sans-serif;"><b>After mirroring, validate anything about the other person's perspective that you agree with or find commendable</b> (e.g. "I really like that you're concerned about whether or not this piece of legislation is fair.&nbsp; I have the same concern;" "I can see that you really care about others' suffering, and I admire your compassion.").</span></li><li><span style="font-family: Verdana, sans-serif;"><b>After validating, introduce your own perspective, using "<a href="http://www.psychologytoday.com/blog/cui-bono/201211/are-i-statements-better-you-statements" target="_blank">I-language</a>"</b> (e.g. I feel, I think, I'm concerned about, I believe, I'd prefer, etc.).</span></li><li><span style="font-family: Verdana, sans-serif;"><b>Try to keep the dialogue respectful</b> (e.g. monitor your tone of voice, avoid interrupting, avoid labeling and exaggerating, etc.).&nbsp; If your notice yourself getting too upset, you can acknowledge that you are too passionate about the issue to have a respectful dialogue at the moment and can politely terminate or postpone the conversation.&nbsp; You can later reflect on what was going in within you as the topic was being discussed.&nbsp; In the words of Confucius, "When we see men of a contrary character, we should turn inwards and examine ourselves."</span></li><li><span style="font-family: Verdana, sans-serif;"><b>Release the need to be "right" or the need for the other person to see things as you do.</b>&nbsp; Political, religious, and moral issues are controversial precisely because there are so many valid, reasonable points on both sides of the argument.&nbsp; Practice accepting that others do not believe as you do and shift your attention to (a) understanding the other person's perspective; (b) attempting to help the other person to understand yours.&nbsp; The goal here is <i>understanding</i>, not necessarily persuasion.</span></li></ol><br /><span style="font-family: Verdana, sans-serif;">I can think of no better way to end this post than by sharing some of Haidt's concluding words in his book <i>The Righteous Mind: Why Good People Are Divided by Politics and Religion</i>: "Morality binds and blinds.&nbsp; It binds us into ideological teams that fight each other as though the fate of the world depended on our side winning the battle.&nbsp; It blinds us to the fact that each team is composed of good people who have something important to say...if you really want to open your mind, open your heart first.&nbsp; If you can have at least one friendly interaction with a member of the 'other' group, you'll find it far easier to listen to what they're saying, and maybe even see a controversial issue in new light." </span><br /><b><span style="font-family: Verdana, sans-serif;"><br /></span></b><b><span style="font-family: Verdana, sans-serif;">Resources</span></b><br /><br /><span style="font-family: Verdana, sans-serif;">How do you score on the Moral Foundations Questionnaire?&nbsp; <a href="http://www.yourmorals.org/" target="_blank">Take the test online for free and find out</a>!</span><br /><span style="font-family: Verdana, sans-serif;">Interested in Haidt's work?&nbsp; Consider reading his book, <a href="http://www.amazon.com/Righteous-Mind-Divided-Politics-Religion/dp/0307377903" target="_blank"><span style="font-family: Verdana, sans-serif;"><i>The Righteous Mind: Why Good People Are Divided by Politics and Religion.</i></span></a></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span>Aaron Norton, LMHC, LMFThttp://www.blogger.com/profile/00635484623173913946noreply@blogger.com1tag:blogger.com,1999:blog-2321285534867921261.post-11954736033534118072012-11-18T17:42:00.000-08:002012-11-18T19:37:13.299-08:00How to Test, Challenge, and Replace Unhealthy Thoughts<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><b><br /><br /><br /></b></span><br /><div class="separator" style="clear: both; text-align: center;"><span style="font-family: Verdana, sans-serif;"><b><a href="http://2.bp.blogspot.com/-nrGkUe_PxoQ/UKlsG7HYeNI/AAAAAAAAAEo/QWh_z5MDrOQ/s1600/Epictetus.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="195" src="http://2.bp.blogspot.com/-nrGkUe_PxoQ/UKlsG7HYeNI/AAAAAAAAAEo/QWh_z5MDrOQ/s320/Epictetus.JPG" width="320" /></a></b></span></div><span style="font-family: Verdana, sans-serif;"><b><br /><br /></b></span><br /><div style="text-align: left;"><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;">In my last post, I introduced <a href="http://aaronlmhc.blogspot.com/2012/11/cognitive-distortions-six-mind-games.html" target="_blank">six cognitive distortions</a>, or irrational thought processes, that can fuel unpleasant feelings.&nbsp; Today, I'm going to show you a model that you can use to test irrational thoughts and replace them with more helpful thoughts that tend to relieve emotional distress.&nbsp;&nbsp;</span></span><br /><br /><span style="font-family: Verdana, sans-serif;"></span><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;">The tool I'm going to introduce is one that I often use in session with my clients and that is rooted in a concept called <b>collaborative empiricism</b>.&nbsp; It is a process by which the client and therapist work together as if investigators or scientists to examine one of the client's thoughts and determine if it is rational or irrational.&nbsp; In other words, a good cognitive therapist will not simply tell you whether or not your thoughts are rational.&nbsp; Instead, the therapist will help guide you through a structured process designed to test your thoughts out.&nbsp; You and your therapist will then determine whether or not the thought has withstood this test of logic.</span></span><br /><br /><span style="font-family: Verdana, sans-serif;"></span><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;">Before I describe this test, I'd like to offer two words of caution.&nbsp; First, I want to remind you that reading this post and experimenting with this tool is no substitute for therapy.&nbsp; I recommend visiting a cognitive behavioral therapist to learn how to use this tool and to experience the other benefits that come from working within the context of a therapeutic relationship.&nbsp; This is all the more important if you are experiencing significant emotional distress. You can locate such a therapist in your area by visiting <a href="http://therapists.psychologytoday.com/rms/prof_search.php" target="_blank"><i>Psychology Today's Therapy Directory</i></a>, entering your zip code, and then clicking on "Cognitive Behavioral Therapy" under the heading "Treatment Orientation." Second, I'd like to caution you against using this tool to judge yourself negatively.&nbsp; Remember that all human beings think irrationally every single day-it's part of the human experience.&nbsp; It's okay to be imperfect.</span></span><br /><br /><span style="font-family: Verdana, sans-serif;"></span><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;"></span><span style="font-family: Verdana, sans-serif;">With that disclaimer, aside, let me introduce this powerful tool.&nbsp; It includes three basic steps (some of which are divided below into more detailed steps):</span></span><br /><span style="font-family: Verdana, sans-serif;"></span><span style="font-family: Verdana, sans-serif;"></span><span style="font-family: Verdana, sans-serif;"></span><br /><ol><span style="font-family: Verdana, sans-serif;"><li><span style="font-family: Verdana, sans-serif;"><b>Conduct a <a href="http://ptsd.about.com/od/glossary/g/chainanalysis.htm" target="_blank">chain analysis</a> </b>(also referred to as a "functional analysis") of the event.&nbsp; Map out the whole event including what happened that triggered your feeling, how you felt, what you thought about the event, and what you did to respond to it.</span></li><li><span style="font-family: Verdana, sans-serif;"><b>Test the thoughts that you experienced during or after the event to determine if any of them were irrational</b>.&nbsp; If you identify any irrational thoughts, then you would move on to the third step.</span></li><li><span style="font-family: Verdana, sans-serif;"><b>Revise or replace the irrational thought with a healthier, helpful, and logical thought</b> (i.e. a rational thought).</span></li></span></ol><span style="font-family: Verdana, sans-serif;"></span></div><div style="text-align: left;"><br /><span style="font-family: Verdana, sans-serif;"></span><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;">Let me focus in greater detail on each of these three basic steps:</span></span><br /><span style="font-family: Verdana, sans-serif;"></span><b><br /></b><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;"><b>Step One: Conduct a Chain Analysis</b> </span></span><br /><span style="font-family: Verdana, sans-serif;"></span><span style="font-family: Verdana, sans-serif;"></span><br /><ol><span style="font-family: Verdana, sans-serif;"><li><span style="font-family: Verdana, sans-serif;"><b>Describe the situation that triggered your unpleasant feeling.</b>&nbsp; This may involve a specific event, such as a driver cutting you off on the road or waking up after an unpleasant dream, but sometimes the trigger is less clear.&nbsp; If you can't identify an event that triggered your feeling, then consider noticing the signs of the uncomfortable feeling to be the trigger (e.g. I noticed that my heart was beating faster and that I was feeling tense).&nbsp; It is important that when you describe the situation, you avoid any interpretations, beliefs, assumptions, or conclusions.&nbsp; Its best to describe the situation using specific, objective, and succinct words, like as though a reporter were describing the situation or a camera were filming it (e.g. Instead of writing, "My boss was being a jerk," you would write some something like, "My boss asked me why I was late this morning, rolled his eyes at me when I answered, and then walked away").</span></li><li><span style="font-family: Verdana, sans-serif;"><b>Identify the specific names of the feelings that you experienced at the time of the triggering event</b> (e.g. angry, anxious, depressed, frustrated, guilt, ashamed, etc.).&nbsp; Try to scale how intense that feeling was at the time of the event using a scale that ranges from zero to 100.&nbsp; For example, if the feeling was anger, then a score of 100 would mean that think that it would be virtually impossible for you to feel any more angry.&nbsp; Typically, this would mean that your anger was so intense that you lost control, perhaps throwing things, yelling, or maybe even hitting someone or damaging property.&nbsp; A score of 50 would mean that you experienced a moderate, significant, and uncomfortable anger but still felt like you had control.&nbsp; A score of 10 would mean that you experienced such a mild form of anger (perhaps a minor irritation, frustration, or annoyance, for example), that you barely noticed it.</span></li><li><span style="font-family: Verdana, sans-serif;"><b>Identify the physical and behavioral symptoms of the feeling.&nbsp;</b> These can include sensations in your body (e.g. increased heart rate, choking feeling in your throat, increased muscle tension, rapid breathing, nausea, trembling, etc.) or things that you did when you felt the feeling (e.g. yelled, ran away, slammed a door, threw something, called someone a name, etc.).</span></li><li><span style="font-family: Verdana, sans-serif;"><b>Identify the thoughts that were running through your mind when the event happened.&nbsp;</b> This is easier said than done, and people sometimes have a difficult time with this step until they have practiced it several times with the help of a therapist.&nbsp; Sometimes, it might help you to ask questions like, "Why was I feeling anxious in this situation?"&nbsp; The reasons you come up with may represent the thoughts that you were having at the time of the event.&nbsp; </span></li></span></ol><span style="font-family: Verdana, sans-serif;"></span></div><div style="text-align: left;"><br /><b><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;">Step Two: Test the Thoughts You Experienced During/After the Event</span></span></b><br /><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;">This test includes seven questions that you can ask yourself in order to reach a conclusion about whether the thought is logical (i.e. makes sense, is supported by evidence, and is contradicted by little or no evidence) and adaptive (i.e. helps you to function, gives you good results that you are satisfied with):</span></span><br /><span style="font-family: Verdana, sans-serif;"></span><span style="font-family: Verdana, sans-serif;"></span><br /><ol><span style="font-family: Verdana, sans-serif;"><li><span style="font-family: Verdana, sans-serif;"><b>Do any of these thoughts look like cognitive distortions?</b>&nbsp; <a href="http://aaronlmhc.blogspot.com/2012/11/cognitive-distortions-six-mind-games.html" target="_blank">Review the list of cognitive distortions I described in my previous post</a> and decide if any of them seem to match up with your thoughts about this event.</span></li><li><span style="font-family: Verdana, sans-serif;"><b>What is the evidence for and against this thought?</b>&nbsp; First, pretend that you are a prosecuting attorney and that you must convince a prudent judge and a jury of 12 reasonable people that this thought, is in fact, true beyond even a shadow of reasonable doubt.&nbsp; What evidence would you bring to the table?&nbsp; Identify and review each piece of evidence.&nbsp; When you have run out of ideas, pretend that you are a defending attorney who must poke holes at the prosecution's argument that you previously detailed.&nbsp; Your paycheck and reputation as an attorney now depend on your ability to raise a shadow of reasonable doubt that the thought is true.&nbsp; Identify and review all the evidence that you can think of.&nbsp; (People who are not well-trained at using this tool typically need the help of a therapist with this step.&nbsp; Alternatively, a trusted family member or friend whose perspective you value may be able to help you come up with some ideas.)&nbsp; Decide which side seems to have presented a stronger argument.</span></li><li><span style="font-family: Verdana, sans-serif;"><b>What are some other options for how to think of this situation?</b>&nbsp; When a scientist or an investigator observes something that she can't explain, she first identifies different hypotheses, or educated guesses about what may be happening.&nbsp; When it comes to questioning our thoughts, we can do the same.&nbsp; You would identify every possible way of interpreting or thinking about this event that can come up with, no matter how unlikely some of these explanations might seem.</span></li><li><span style="font-family: Verdana, sans-serif;"><b>What is the worst that could possibly happen from this situation?</b>&nbsp; This question is optional and is best asked when a thought seems to fit into the cognitive distortion known as Catastrophizing, meaning that you are exaggerating the negative aspect of a situation.&nbsp; For example, if the triggering event involved your tire going flat, and you think, "This is horrible!&nbsp; I can't handle this," then you might decide that the worst that could happen is that you will have to spend a few minutes changing your tire out on the side of the road or will have to wait for roadside assistance and that you will later have to spend some money to replace the tire.&nbsp; You would then ask questions like, "Would that really be so bad?&nbsp; Would I be able to stand it?&nbsp; Would I survive it?&nbsp; In the grand scheme of things, would I eventually be okay?" You can also ask yourself what the best case scenario would be, and what the most realistic outcome would be (typically something in between the best and worst case scenarios).</span></li><li><span style="font-family: Verdana, sans-serif;"><b>What is the effect of me having this thought? </b>Here, you would think about how this thought is affecting your emotions, choices, and behaviors.&nbsp; Is it feeding strong, unpleasant feelings?&nbsp; Do you like the way you handled it?&nbsp; Is it giving you good or bad outcomes?&nbsp; Do you like where this reasoning is taking you?&nbsp; Is it hurting you or helping you?&nbsp; It is improving your circumstances?&nbsp; Is it holding you back in some way?</span></li><li><span style="font-family: Verdana, sans-serif;"><b>What could I do about this situation?&nbsp;</b> This question helps you to pull yourself out of your feelings and thoughts about the circumstance (reactive) and shift your focus to solutions that may empower you (proactive).&nbsp; You may find that some ideas pop up in your head that suggest that the situation isn't as bad as you originally thought or is much more manageable than it seemed at first.</span></li><li><span style="font-family: Verdana, sans-serif;"><b>If my friend or loved one was in this situation and had this thought, what would I tell him or her?&nbsp;</b> This question pulls you out of your limited perspective for a moment and puts you in the more objective, less emotionally attached position of being a third party observer who cares about the person who is struggling.&nbsp; It allows you to start considering some other perspectives.</span></li></span></ol><span style="font-family: Verdana, sans-serif;"><b><span style="font-family: Verdana, sans-serif;">Step Three: Revise or Replace the Irrational Thought</span></b></span></div><div style="text-align: left;"><br /><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;">If the seven questions you asked yourself in Step Two lead you to the conclusion that your thought was irrational, then the next step would be to tweak that thought so that it is more rational.&nbsp; Below, I'll suggest some conversions for the <a href="http://aaronlmhc.blogspot.com/2012/11/cognitive-distortions-six-mind-games.html" target="_blank">six cognitive distortions I outlined in my previous post</a>.</span></span><br /><span style="font-family: Verdana, sans-serif;"></span><br /><ol><span style="font-family: Verdana, sans-serif;"><li><span style="font-family: Verdana, sans-serif;">All-or-None Thinking: <b>Consider a new thought that pulls your conclusion away from an extreme stance and into a more balanced "gray area."&nbsp;</b> For example, if you concluded that a training seminar you attended for work was "a complete and total waste of my time," you might consider a thought like, "The training wasn't as helpful as I wanted it to be, but a few things were worth hearing."</span></li><li><span style="font-family: Verdana, sans-serif;">Jumping to Conclusions: <b>Rewrite the thought to be less conclusive or to raise questions instead of defaulting to assumptions.</b>&nbsp; For example, if you're driving down the road, a driver cuts you off before making a sharp turn onto a side street, and you conclude that he's a jerk, you might consider a thought like, "I have no idea what's going on with this guy, but he's not driving safe.&nbsp; Maybe he's not paying attention, maybe he's experiencing an emergency, but I doubt he's intentionally trying to harm me."</span></li><li><span style="font-family: Verdana, sans-serif;">Magnifying or Minimizing: <b>Revise the thought to include evidence that contradicts your initial thought.&nbsp;</b> For example, if you see a TV story about a veteran who suddenly became violent and started hurting people, and you thought something like "Veterans are dangerous, unstable people who have issues," you might replace it with a thought like "Some veterans are unstable, but now that I think of it I know of stories of veterans who are doing wonderful things for their communities, and I've only seen a small handful of stories about them doing something harmful."</span></li><li><span style="font-family: Verdana, sans-serif;">Personalizing or Blaming: <b>Revise the thought so that it no longer defaults to a conclusion that is either solely about you or solely about others.&nbsp; </b>For example, if you're on the phone with an angry customer, replace thoughts like "What did I do that was so wrong?&nbsp; Why is this lady being so rude?" with thoughts like "She may be angry for reasons that have little or nothing to do with me, but I also may have played a part in her anger."</span></li><li><span style="font-family: Verdana, sans-serif;">Imperatives: <b>Convert the absolute statement into a personal preference or possibility.&nbsp;</b> For example, replace "I should have caught that mistake" with "I wish I'd caught that mistake, but I can't catch them all."&nbsp; Similarly, a thought like "Those two should not be together" could be replaced with "I don't think those two are a very compatible."</span></li><li><span style="font-family: Verdana, sans-serif;">Emotional Reasoning: <b>Accept that you are having an emotional response while acknowledging that the emotion isn't a fact and doesn't have to prove anything.&nbsp;</b> For example, if you reason "I feel guilty, so I must be doing something wrong no matter what others tell me," you can think "I know I'm feeling guilty, but that doesn't necessarily mean I'm doing something wrong."</span></li></span></ol><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;">That's it, folks!&nbsp; I've presented a tool that I hope you find helpful in recognizing or replacing irrational thoughts.&nbsp; A few more notes on this tool: First, the aim of this tool isn't to completely erase all unpleasant feelings.&nbsp; Unpleasant feelings can be healthy and functional.&nbsp; In fact, they are necessary for our survival.&nbsp; Instead, the tool often reduces the intensity of unpleasant emotions so that you can think more clearly and react more intentionally.&nbsp; Second, this tool will probably only be helpful if you use it repeatedly, and there are a number of tools that you can use to train yourself.&nbsp; In addition to attending sessions with a Cognitive Behavioral therapist until you have mastered the process, you can use paper tools such as the <a href="http://bridgmandocs.com/forms/DTR.pdf" target="_blank">Dysfunctional Thought Record</a> or the <a href="http://www.rebtnetwork.org/library/shf.html" target="_blank">REBT Self-Help Form</a>.&nbsp; I'm also a big fan of using <a href="http://anorton.com/RecommendedApps.en.html" target="_blank">smart phone apps and tablet apps</a>.&nbsp; If you enter the term "CBT" into your device's app store, you can experiment with a number of helpful tools.</span></span></div></div>Aaron Norton, LMHC, LMFThttp://www.blogger.com/profile/00635484623173913946noreply@blogger.com1tag:blogger.com,1999:blog-2321285534867921261.post-41000192535594316222012-11-09T10:20:00.001-08:002012-11-09T12:33:13.370-08:00Cognitive Distortions: Six Mind Games that Keep Us Unhappy<div class="separator" style="clear: both; text-align: center;"><a href="http://www.brainleadersandlearners.com/wp-content/uploads/2008/09/blog-brain-business2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="http://www.brainleadersandlearners.com/wp-content/uploads/2008/09/blog-brain-business2.jpg" width="200" /></a></div><div><span style="font-family: Verdana, sans-serif;"><br /></span></div><span style="font-family: Verdana, sans-serif;"></span><br /><div><span style="font-family: Verdana, sans-serif;"><span style="font-family: Verdana, sans-serif;"><br /></span></span></div><span style="font-family: Verdana, sans-serif;">When I experience a strong, negative, or unpleasant emotion, I think of that feeling as a "red flag" that I'm thinking irrationally. &nbsp;What do I mean by "irrationally?" &nbsp;Irrational thoughts have two characteristics: (1) They are illogical, meaning they don't make sense, there is a relative lack of evidence to support them, and there is a relatively stronger case against them; and (2) They are maladaptive, meaning they don't help me function well in my environment--they work against me. &nbsp;</span><br /><div><span style="font-family: Verdana, sans-serif;"><br /></span></div><div><span style="font-family: Verdana, sans-serif;">All human beings think both rationally and irrationally; it's part of the human condition. &nbsp;We're wired that way. &nbsp;And many of these thoughts happen automatically, with little or no conscious effort on our part. &nbsp;We all have our own unique cognitive filters. &nbsp;We tend to filter new information about things that happen our lives through a filter of past memories and experiences. &nbsp;The problem is that some of these filters skew, twist, and warp the picture to keep us feeling, thinking, and acting in unhealthy ways.</span></div><div><span style="font-family: Verdana, sans-serif;"><br /></span></div><div><span style="font-family: Verdana, sans-serif;">In today's post, I'm going to outline six different cognitive distortions that hinder us. &nbsp;Cognitive distortions are irrational thought processes, or as some people define them, thinking errors. &nbsp;Before you read on, understand that we all use these distortions. &nbsp;In fact, we use them on a daily basis, even if we are relatively unaware that they're humming around in the background. &nbsp;So I invite you to suspend judgment about yourself, give yourself permission to be human, and identify which of these distortions you think you tend to use the most.</span></div><div><span style="font-family: Verdana, sans-serif;"><br /></span></div><div><div class="MsoNormal"><span style="font-family: Verdana, sans-serif;"><b><span style="line-height: 115%;">1) All-or-None Thinking</span></b><span style="line-height: 115%;"> (a.k.a. <b>Dichotomous Thinking</b>, <b>Polarized Thinking</b>): You look at things in absolute, black and white categories, ignoring other possibilities that might lie on a spectrum somewhere in between or outside of the two categories.&nbsp; (Examples: “You’re either for me or against me,” excluding other possibilities such as being neutral or having mixed thoughts or feelings for or against; or “You’re either part of the problem, or part of the solution,” excluding the possibility that someone could in some ways contribute to a problem and in other ways contribute to a solution.)<o:p></o:p></span></span></div><div class="MsoNormal"><span style="line-height: 115%;"><span style="font-family: Verdana, sans-serif;"><br /></span></span></div><div class="MsoNormal"><span style="font-family: Verdana, sans-serif;"><b><span style="line-height: 115%;">2) Jumping to Conclusions: </span></b><span style="line-height: 115%;">You draw a conclusion somewhat prematurely based on very limited information. &nbsp;Can include:<o:p></o:p></span></span></div><div class="MsoNormal"></div><ul><li><span style="font-family: Verdana, sans-serif;"><b><span style="line-height: 115%;">Overgeneralizing</span></b><span style="line-height: 115%;">: You make a sweeping negative conclusion that goes far beyond the current situation.&nbsp; (Example: “I was so lost in class today. &nbsp;I can’t do math,” generalizing confusion about <i>one </i>particular math-related topic on <i>one</i> day to <i>all </i>math-related topics on <i>all </i>days.)&nbsp;</span></span></li><li><span style="font-family: Verdana, sans-serif;"><b><span style="line-height: 115%;">Labeling</span></b><span style="line-height: 115%;">: A variation of Overgeneralization that occurs when you apply a fixed, global, or absolute label to yourself or others, often taking the form of name-calling.&nbsp; (Example: “I’m such an idiot!” after spilling a drink on the carpet, or “What a jerk” after another driver almost hits you on the road because he or she didn’t check a “blind spot” before trying to merge.)</span></span></li><li><span style="font-family: Verdana, sans-serif;"><b><span style="line-height: 115%;">Mind Reading</span></b><span style="line-height: 115%;">: You believe you know what others are thinking or feeling while failing to consider other more likely possibilities.&nbsp; (Example: “They don’t think I know what I’m doing” when giving a presentation you are nervous about, ignoring the possibility that others think you’re doing fine or aren’t particularly focused on evaluating you one way or the other.)</span></span></li><li><span style="font-family: Verdana, sans-serif;"><b><span style="line-height: 115%;">Catastrophizing</span></b><span style="line-height: 115%;"> (a.k.a. <b>Fortune Telling, Awfulizing</b>): You predict the future negatively and/or exaggerate the negative aspect of a situation without considering other more likely outcomes.&nbsp; (Examples: “I’m going to screw this up;” “I’m going to be late, my boss will get mad, I’ll get fired, I won’t be able to pay the bills, and I’ll end up homeless!”)</span></span></li></ul><br /><div class="MsoNormal"><span style="font-family: Verdana, sans-serif;"><b><span style="line-height: 115%;">3) Magnifying</span></b><span style="line-height: 115%;"> or <b>Minimizing</b>: You magnify one aspect of a situation and/or minimize other aspects.&nbsp; This can include:<o:p></o:p></span></span></div><div class="MsoNormal"></div><ul><li><span style="font-family: Verdana, sans-serif;"><b><span style="line-height: 115%;">Mental Filter </span></b><span style="line-height: 115%;">(a.k.a. <b>Filtering,</b> <b>Selective Abstraction, Tunnel Vision, Confirmation Bias</b>)<b>: </b>Paying undue attention to one or a small number of pieces of information while ignoring or failing to see the whole picture.&nbsp; (Example: “My presentation sucked” after receiving some constructive criticism from one or two attendees even though a dozen others gave you excellent reviews, ratings, and compliments.)</span></span></li><li><span style="font-family: Verdana, sans-serif;"><b><span style="line-height: 115%;">Disqualifying/Discounting the Positive: </span></b><span style="line-height: 115%;">You unreasonably tell yourself that positive experiences, deeds, or qualities do not count (Example: “I only got a positive evaluation because my boss was being nice;” “I only met my quota because I got lucky.”)</span></span></li></ul><br /><div class="MsoNormal"><span style="font-family: Verdana, sans-serif;"><b><span style="line-height: 115%;">4) Personalizing</span></b><span style="line-height: 115%;"> or <b>Blaming</b>: You believe others are behaving, thinking, acting or feeling a certain way because of you, without considering other more plausible explanations for their behavior (Personalization).&nbsp; Conversely, you may blame others for your thoughts, feelings, or behaviors while overlooking ways that your own attitudes and behavior might contribute to a problem (Blaming).&nbsp; (Examples: “What did I ever do to him to make him look at me that way?” “You’re making me so mad!”)<o:p></o:p></span></span></div><div class="MsoNormal"><b><span style="line-height: 115%;"><span style="font-family: Verdana, sans-serif;"><br /></span></span></b></div><div class="MsoNormal"><span style="font-family: Verdana, sans-serif;"><b><span style="line-height: 115%;">5) Imperatives</span></b><span style="line-height: 115%;"> (a.k.a. <b>Shoulding/Shoulds</b>, <b>Must Statements, Absolutes, Dogmatic Demands</b>): You have a list of solid, absolute, rigid, inflexible, unreasonable, or ironclad rules and assumptions about how you or others should think, feel, or act.&nbsp; This distortion often contributes to perfectionism or a strong need for control.&nbsp; (Example: “I have to get this right” or “You need to stop doing that.”)&nbsp; Imperatives can be converted into healthier thoughts called <b>Personal Preferences</b>, such as “I’d like/prefer to…,” “I believe that…;” “I think…” or “I want you to …”).<o:p></o:p></span></span></div><div class="MsoNormal"><b><span style="line-height: 115%;"><span style="font-family: Verdana, sans-serif;"><br /></span></span></b></div><div class="MsoNormal"><span style="font-family: Verdana, sans-serif;"><b><span style="line-height: 115%;">6) Emotional Reasoning: </span></b><span style="line-height: 115%;">You think something must be true because you “feel” (actually believe) it strongly, ignoring or discounting evidence to the contrary.&nbsp; In some, it is experienced in relation to deeply held core beliefs that may connect to early developmental experiences that evoke strong emotion.&nbsp; (Example: I make good grades, have won several academic honors, and score high on standardized tests, but I still feel like I’m stupid; like I’m just not good enough.)<o:p></o:p></span></span></div></div><div><span style="font-family: Verdana, sans-serif;"><br /></span></div><div></div><div><span style="font-family: Verdana, sans-serif;">So what do we do about cognitive distortions? &nbsp;Well, you have plenty of options. &nbsp;You can identify them, explore them, study them, test them, accept them, ignore them, act on them, challenge them, feed them, struggle with them, challenge them, or revise them. &nbsp;The approach I favor involves the following process:</span></div><div><ol><li><span style="font-family: Verdana, sans-serif;">Identify them while compassionately accepting that you are using them. &nbsp;Avoid judging yourself for experiencing them.</span></li><li><span style="font-family: Verdana, sans-serif;">Test them out; explore them empirically.</span></li><li><span style="font-family: Verdana, sans-serif;">Depending on the outcome of #2, decide whether you'd like to replace them or simply modify them to be more helpful.</span></li></ol></div><div><span style="font-family: Verdana, sans-serif;">In my next post, I'll walk you through this three-step process.</span></div><div><span style="font-family: Verdana, sans-serif;"><br /></span></div><div><div class="MsoFooter"><span style="font-family: Verdana, sans-serif;">List of Cognitive Distortions adapted from (1) <i><a href="http://www.amazon.com/Cognitive-Behavior-Therapy-Second-Basics/dp/1609185048" target="_blank">Cognitive Therapy: Basics and Beyond</a></i> by Dr. Judith Beck, (2) <i><a href="http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/0380810336/ref=sr_1_1?s=books&amp;ie=UTF8&amp;qid=1352480529&amp;sr=1-1&amp;keywords=feeling+good+the+new+mood+therapy" target="_blank">Feeling Good: The New Mood Therapy</a></i> by Dr. David Burns, and (3) <i><a href="http://www.amazon.com/New-Guide-Rational-Living/dp/0879800429/ref=sr_1_1?s=books&amp;ie=UTF8&amp;qid=1352480586&amp;sr=1-1&amp;keywords=a+guide+to+rational+living+albert+ellis" target="_blank">A Guide to Rational Living</a></i> by Dr. Albert Ellis</span><span style="font-size: 6pt;"><o:p></o:p></span></div></div>Aaron Norton, LMHC, LMFThttp://www.blogger.com/profile/00635484623173913946noreply@blogger.com1tag:blogger.com,1999:blog-2321285534867921261.post-43362499745126475012012-09-06T12:00:00.004-07:002012-11-09T12:32:28.429-08:00Seven Tips for More Affordable Mental Healthcare<div class="separator" style="clear: both; text-align: center;"><a href="http://www.crtmedical.com/wp-content/uploads/2012/05/WP-health_costs.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="http://www.crtmedical.com/wp-content/uploads/2012/05/WP-health_costs.jpg" width="320" /></a></div><span class="Apple-style-span" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.230469); -webkit-composition-frame-color: rgba(77, 128, 180, 0.230469); -webkit-tap-highlight-color: rgba(26, 26, 26, 0.292969);"><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span></span><span class="Apple-style-span" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.230469); -webkit-composition-frame-color: rgba(77, 128, 180, 0.230469); -webkit-tap-highlight-color: rgba(26, 26, 26, 0.292969);"><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span></span><span class="Apple-style-span" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.230469); -webkit-composition-frame-color: rgba(77, 128, 180, 0.230469); -webkit-tap-highlight-color: rgba(26, 26, 26, 0.292969);"><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">For many Americans, access to mental healthcare is a matter of necessity, not a luxury. &nbsp;And for most of us, it's not free. &nbsp;Like other needs, such as food, water, clothing, and shelter, quality healthcare comes at a cost. Impoverished Americans are typically eligible for <a href="http://www.medicaid.gov/" target="_blank">Medicaid or CHIP </a>programs (Children's Health Insurance Programs), retirees have <a href="http://www.medicare.gov/" target="_blank">Medicare</a>, and the wealthy can typically afford their care. &nbsp;So that pretty much leaves middle class Americans of working age to grapple with the burden of affordable mental healthcare. &nbsp;In this post, I'm offering you 7 tips for making your mental healthcare more affordable. &nbsp;I hope you find them helpful.</span></span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><b>1) If you take medication, ask about generics.</b> &nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">I am surprised to find how many of my clients are unaware that many of the medications they are being prescribed are available through generic drug discount programs at major retailers, like <a href="http://www.walmart.com/cp/PI-4-Prescriptions/1078664" target="_blank">Walmart</a>&nbsp;and <a href="http://sites.target.com/site/en/spot/page.jsp?title=pharmacy_generics&amp;ref=nav_phrm_1_3" target="_blank">Target</a>. &nbsp;Some of the most commonly prescribed medications for depression, anxiety, Bipolar Disorder, and psychotic disorders are available for $4 for a 30-day supply or $10 for a 90-day supply. &nbsp;For most of us, buying medications through generic drug programs is less expensive than purchasing through insurance, and for those of us without insurance, these programs are a godsend. &nbsp;Ask your prescribing physician if there is a generic available for any name-brand scripts. &nbsp;Make sure that your physician knows that you prefer generic medications when appropriate and that your pharmacist knows that you consent to receiving generics when they are available. &nbsp;Your physician may determine that a generic medication is not the right fit for you, and many medications are not available in a generic form, but you may never know if you don't talk about it.</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><b>2) If you don't have health insurance and can't afford your medication, consider applying for a prescription assistance program.</b> &nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">Many pharmaceutical companies and charitable organizations offer free or discounted medications to uninsured patients. You can apply for assistance through the <a href="http://www.pparx.org/" target="_blank">Partnership for Prescription Assistance</a>. &nbsp;Fortunately, many clients I've referred to this resource over the past 7 years have been able to get help.</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><b>3) If you don't have health insurance, start shopping. </b>&nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">Signed into law by President Obama on March 23, 2010, the <a href="http://www.healthcare.gov/law/index.html" target="_blank">Affordable Care Act</a> requires most Americans to purchase health insurance beginning in 2014, a requirement known as the <a href="http://healthreform.kff.org/the-basics/Requirement-to-buy-coverage-flowchart.aspx" target="_blank">individual mandate</a>. &nbsp;By 2016, the penalty for noncompliance will be $695 per adult and $347.50 per child with a maximum penalty of $2,085 per family. &nbsp;Purchasing health insurance is not just just a good idea; it's now the law. &nbsp;Treat the purchase of health insurance just as you would any other significant investment, like a car or a home. &nbsp;Comparison shop with multiple companies and plans. &nbsp;An insurance agent or underwriter may be helpful in customizing a plan that works for you. &nbsp;Ask friends and family members what insurance they've purchased and whether or not they're happy with their plan. &nbsp;If you keep getting denied coverage because of pre-existing conditions, understand that beginning in 2014, insurance companies will be prohibited from denying coverage. &nbsp;In the meantime, you can obtain insurance either through a <a href="https://pcip.gov/Costs_Benefits.html" target="_blank">federal pre-existing insurance plan</a>&nbsp;or a <a href="http://www.nahu.org/consumer/hrpguide.cfm" target="_blank">state high risk pool</a>. &nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">Even without a pre-existing condition, health insurance can be expensive depending on a range of factors, such as age, gender, body mass, lifestyle habits, and place of residence. &nbsp;And those of us who are self-employed or whose employers don't offer a health plan miss out on three advantages of employer-based insurance plans:&nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">(1) We have to pay for &nbsp;the entire premium ourselves instead of splitting the cost with our employer;&nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">(2) We can't purchase our plans with pre-taxed earnings as companies can; and&nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">(3) We don't get a discount for buying in bulk. &nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">But there are some ways to compensate for these drawbacks. &nbsp;If you are the member of a professional association, see if your association works with an insurance company that offers reduced rates for members. &nbsp;When I transitioned into private practice, I was afraid that I'd have to pay hundreds of dollars a month for insurance, but by going through the American Counseling Association, I found a good plan with a $1,500 deductible and a 40% coinsurance rate for just over $80 a month. &nbsp;Consider a plan with a higher deductible, often known as <a href="http://healthinsurance.about.com/od/glossary/g/catastrophic.htm" target="_blank">catastrophic coverage</a>. &nbsp;These high-deductible policies may be more affordable and will generally work well for more expensive and serious medical costs, but you will have to pay for smaller expenses until you meet your deductible. &nbsp;The good news is that the rate you pay for these expenses will be discounted, as the provider will bill you for the same contracted rate that your insurance company would typically pay for. &nbsp;Nonetheless, the steeper your deductible, the greater the possibility that you will be paying for a lot of out-of-pocket expenses. &nbsp;And that brings me to my fourth tip.</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><b>4) Put money aside each month for out-of-pocket medical expenses.</b></span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"> &nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">I know this is easier said than done. &nbsp;Everyone plans to put some money aside, but few of us ever seem to get around to it. &nbsp;I recommend that you start off by completing a <a href="http://www.kiplinger.com/tools/budget/" target="_blank">household budget</a>. &nbsp;Based on the income you have left after your expenditures, decide how much money you can reasonably invest in healthcare savings. &nbsp;If you don't have enough left over to invest, then the next question becomes, "What can I cut in my budget to make my health a priority?" &nbsp;If I'm not saving up money for my health expenditures, but I have the newest iPhone and a premium cable plan with so many channels that I could watch a new one everyday of my life for 5 years, then I might want to question my priorities. &nbsp;Think about it this way: <a href="http://www.bls.gov/news.release/cesan.nr0.htm" target="_blank">The typical American family spends about 5% of its income on healthcare</a>, which is a little more than half of what it spends on food, another basic necessity. &nbsp;Some cost-saving measures can be as simple as making coffee at home instead of buying it at a restaurant or preparing more meals at home instead of eating out. &nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">If you're like me, you may need a little extra help in staying disciplined enough to put some money aside, so I'll offer three options that may help you:&nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">(1) If you are not self-employed, consider a <a href="http://www.irs.gov/publications/p969/ar02.html#en_US_2011_publink1000204174" target="_blank">flexible spending account (FSA)</a>. &nbsp;FSAs allow you to put aside a little money every month to save for healthcare expenses, and since that money is pre-taxed income, you're saving on your healthcare expenses. &nbsp;But be careful; FSAs operate on what's called a "use it or lose it" principle, meaning that you lose anything left over in the account by the end of the year. &nbsp;For this reason, it's best to base your estimate on a typical year's worth of healthcare expenditures. &nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">(2) Regardless of whether or not you're self-employed, <a href="http://www.irs.gov/publications/p969/ar02.html#en_US_2011_publink1000204020" target="_blank">health savings accounts (HSAs)</a>&nbsp;tend to be a good strategy if your insurance plan is a <a href="http://personalinsure.about.com/od/health/a/aa071208a.htm" target="_blank">high deductible health plan</a>. &nbsp;Like FSAs, HSAs allow you to put aside some pre-taxed money every month for healthcare expenses. &nbsp;But unlike FSAs, you don't lose money that you don't spend by the end of the year. &nbsp;The bad news bout FSAs and HSAs is that the Affordable Care Act (ACA) places some significant limitations on the use of such programs. &nbsp;For example, people with FSAs used to spend their remaining funds on routine over-the-counter (OTC) healthcare supplies at the end of the year to avoid losing their balance, purchasing common household items like vitamins and cold and flu medications. &nbsp;But <a href="http://www.irs.gov/uac/Affordable-Care-Act:-Questions-and-Answers-on-Over-the-Counter-Medicines-and-Drugs" target="_blank">under the ACA, OTC expenditures are no longer permitted for both FSAs and HSAs</a>. &nbsp;The ACA also <a href="http://gsanational.com/new-2500-limit-on-fsa-contributions-beginning-2013" target="_blank">cuts in half the amount you are allowed to invest in FSAs from $5,000 per year to $2,500</a> effective in 2013. &nbsp;Nonetheless, there are still many benefits to HSAs and FSAs. &nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">(3) If you don't have an HSA or FSA, consider creating a separate savings account just for your healthcare expenses. &nbsp;You can also arrange to have money automatically transferred from your checking to savings account on a bi-weekly or monthly basis to help you stay disciplined. &nbsp;Remember that healthcare is a need, not a luxury. &nbsp;It may not be fun to spend money on quality care, but our challenge is to make it a priority.&nbsp;</span><br /><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><b>5) If you're struggling with the cost of your care, communicate with your provider. &nbsp;</b></span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><b><br /></b></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">Few if any of us relish the idea of admitting that we're having a tough time paying our bills. &nbsp;But if you talk to your providers about your difficulty, they may be able to offer help that could mean the difference between accessing appropriate care or not. &nbsp;First, some practitioners offer sliding scale fees for those who genuinely lack the ability to pay the full rate. &nbsp;Second, some providers offer payment plans that allow you to pay your bill in installments. &nbsp;Third, some practitioners may offer you a discount if you pre-pay for services or pay at the time of your appointment. &nbsp;Fourth, your provider may be able to refer you to an appropriate community resource to help you reduce your expenses. &nbsp;In my area, I know of programs that will provide free psychiatric care and counseling for individuals with a limited income and no health insurance, but clients are often unaware of such resources. &nbsp;Finally, some providers offer free or pro bono services in the rare event that a client is both ineligible for public assistance and realistically unable to pay even a sliding scale rate. &nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">Asking for help is easier said than done. &nbsp;Many of us highly value our independence and autonomy. &nbsp;We like to think of ourselves as self sufficient--of being able to handle our own expenses. &nbsp;Consequentially, the idea of using a community resource or charitable program is an uncomfortable one. &nbsp;But if it means the difference between taking care of yourself or not, then it makes sense to accept a little help. &nbsp;You can always remind yourself that such help is temporary and that you can donate to a charitable program in the future when you find yourself in better circumstances as a form of compensation.</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">One more note on asking for help; If you are experiencing a true psychiatric emergency (i.e. suicidal thoughts or plans, thoughts of harming others), you can be admitted to an ER, an inpatient psychiatric program, or a crisis stabilization center immediately regardless of your ability to pay. &nbsp;In some cases, your costs will be covered by local, state, or federal funds or by charitable funds. &nbsp;In other cases, you may be billed for the services with the option of a payment plan, but the bottom line is that getting help is more important than ability to pay. &nbsp;It's crucial that you get the help you need immediately.</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><b>6) Supplement your treatment with healthy lifestyle choices and therapy assignments at home. &nbsp;</b></span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">You can maximize your progress and minimize the potential for a costly relapse by supplementing your therapy with changes in your day-to-day behaviors. &nbsp;If you're taking medication, be sure that you take it regularly and on schedule so that it can do its job. &nbsp;Learn about and implement a <a href="http://www.health.com/health/gallery/0,,20351257,00.html?xid=depressionnews02142012" target="_blank">diet that gives your body the resources it needs to preserve your mental health</a>. &nbsp;Regular <a href="http://www.psychologytoday.com/articles/200301/move-boost-mood" target="_blank">exercise can stimulate mood-enhancing neurotransmitter regulation</a>, boosting your mood. &nbsp;Completing <a href="http://ukpmc.ac.uk/articles/PMC2939342//reload=0;jsessionid=htJuV3cZ1hNUPhYyrUos.0" target="_blank">therapy homework assignments between sessions is associated with greater symptom relief</a>, so if your therapist is giving you something to do between sessions, do your best to follow through. &nbsp;And if you're not being given therapy assignments, then ask about it. &nbsp;And while you're at it, ask your therapist about recommended self-help books. &nbsp;Consider supplementing your therapy and self-help work with participation in a <a href="http://anorton.com/SupportGroups.en.html" target="_blank">community support group</a>, most of which are free. &nbsp;If you're only relying on medication for mental health treatment, then I strongly recommend that you meet with a psychotherapist for counseling. &nbsp;Study after study shows, for example, that <a href="http://www.ncbi.nlm.nih.gov/pubmed/10401443" target="_blank">depressed patients who participate in cognitive therapy show greater improvement</a>. &nbsp;Finally, avoid heavy alcohol consumption and the use of illicit drugs. &nbsp;All substances that produce euphoria also interfere with brain chemistry, and such interference can counteract the therapeutic effects of medication, <a href="http://pubs.niaaa.nih.gov/publications/medicine/Harmful_Interactions.pdf" target="_blank">interact in harmful ways with medication</a>, or make it difficult for your physician to assess whether or not a medication is helping. &nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><b>7) If you can't afford to see a psychiatrist, consider visiting a <a href="http://store.samhsa.gov/mhlocator" target="_blank">community mental health center</a> (CMHC), a <a href="http://www.apna.org/i4a/pages/index.cfm?pageid=3292" target="_blank">Psychiatric Advanced Registered Nurse Practitione</a>r (ARNP), or a <a href="http://patients.about.com/od/doctorsandproviders/a/primarycare.htm" target="_blank">primary care physician</a> (a.k.a. general practice, family doctor).</b> &nbsp;</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">CMHCs typically receive public and/or charitable funding to assist individuals with limited income who don't have health insurance. &nbsp;While there are certainly exceptions, care at CMHCs may come with a few drawbacks. &nbsp;CMHC providers are often less experienced, and there may be lengthy waiting lists or limits in the frequency of appointments. &nbsp;You may not be able to access psychotherapy to supplement your medication maintenance, and in some cases, the CMHC may not charge you much less than you would pay for some private providers in the community who use a sliding scale. &nbsp;Nonetheless, many people receive quality care at a reduced rate through CMHCs. &nbsp;ARNPs who work in private practice are nurse practitioners who can prescribe medication under the supervision of a psychiatrist. &nbsp;Because they receive less training and education than a psychiatrist, they sometimes charge less than a psychiatrist, and many of them are excellent providers (I refer to a local ARNP frequently). &nbsp;Some primary care physicians are comfortable with prescribing mental health medication, especially in the case of milder depression and anxiety. &nbsp;At the very least, they may be a good resource until you can afford to see a psychiatrist. &nbsp;Some <a href="http://www.msnbc.msn.com/id/32681973/ns/health-health_care/t/study-retail-health-clinics-good-doctors-office/" target="_blank">retail health clinics</a> and <a href="http://www.ccaclinics.org/" target="_blank">convenient care clinics</a> may prescribe common antidepressants at an affordable rate, especially if you are between insurance policies and just need a refill of a medication that's been working for you. <i>To be clear, I generally recommend that clients work with a psychiatrist, as they are the most trained and qualified professionals who prescribed mental health medications.</i> &nbsp;But it would be dishonest for me to deny that many clients receive appropriate care through a PCP, especially in cases of common, simple, and mild mental health conditions.</span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><br /></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><b>The bottom line...</b></span><br /><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><b><br /></b></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif;">I can condense these 7 tips into 4 strategies for more affordable mental healthcare: (1) Communicate with your provider; (2) Supplement your treatment with healthy lifestyle choices; (3) Be an informed consumer when it comes to insurance and healthcare costs; and (4) Budget and save for out-of-pocket expenses. &nbsp;I have seen all 7 of these strategies work for clients who I've personally provided care for, and I hope they can be helpful for you, too. &nbsp;If you have any other tips or resources, feel free to post a comment and share them. &nbsp;</span>Aaron Norton, LMHC, LMFThttp://www.blogger.com/profile/00635484623173913946noreply@blogger.com1tag:blogger.com,1999:blog-2321285534867921261.post-5414954196853045422011-09-25T13:29:00.000-07:002012-10-04T07:43:30.323-07:00Rest for the Weary: 7 Tips For a Good Night's Rest<div class="separator" style="clear: both; text-align: center;"><a href="http://openwideblog.files.wordpress.com/2010/06/j0408908.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="214" src="http://openwideblog.files.wordpress.com/2010/06/j0408908.jpg" width="320" /></a></div><br /><br /><span style="font-family: Verdana, sans-serif;">In my practice, I often meet people who can't seem to get a good night's rest. &nbsp;Some have a tough time falling asleep; others find that they wake up frequently throughout the night. &nbsp;Some fall asleep quickly, but repeatedly wake up too early and can't seem to get back to sleep. &nbsp;Still others sleep well throughout the night, but they never seem to feel rested. &nbsp;I'm not surprised to learn that many of them have been taking sedatives, either over-the-counter or prescription. &nbsp;What does surprise me is the number of people who have been taking sedatives for years, often with little or no success, but have never been advised by their prescribing physician to examine their sleeping habits. &nbsp;And while there certainly is a place for medication in the world of sleep improvement, many of these sedatives impact quality of sleep by keeping people from spending as much time in deeper, slow-wave sleep. &nbsp;Some of these medications come with undesirable side effects, and others have a potential for tolerance or addiction. &nbsp;With time, some people find that the pill stops working as well. &nbsp;In extreme cases, people are eventually sleeping even worse than before they ever started taking the pill.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">At that brings me to a rule-of-thumb to ponder. &nbsp;Medication doesn't teach us anything. &nbsp;A pill is typically not "the cure" <i>per se</i>. &nbsp;In fact, there is no one simple cure to complex problems. &nbsp;Medication is typically a tool that people can use to minimize their symptoms enough to focus on long-term solutions. &nbsp;It often gets people functional enough to learn what they can do to improve their lives.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">So what can we learn to improve our sleep? &nbsp;Here are some non-medication, lifestyle strategies that most of my clients have found helpful. &nbsp;In fact, I have never worked with a client who struggled with sleep who did not at least find these strategies helpful. &nbsp;Some have even found themselves returning to a full night's rest-problem free. &nbsp;These strategies are particularly near and dear to my heart; I use them myself. &nbsp;When I was younger, I repeatedly struggled with falling asleep at night. &nbsp;These days, I <b><i>consistently</i></b> drift off minutes after my head hits the pillow.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Before covering these strategies, it's important for me to stress that difficulty sleeping can be caused by a number of things-lifestyle habits, acute stressors (e.g. relationship problems, work problems, financial problems), mental health disorders (e.g. anxiety disorders, depression, Bipolar Disorder), withdrawal from addictive substances, use of addictive substances (e.g. alcohol, marijuana, cocaine, amphetamines), respiratory disorders, sleep apnea, etc. &nbsp;I encourage my clients to see a physician, preferably a sleep specialist, to rule-out biological disorders that might be impacting sleep. &nbsp;However, clients who typically see me have already sought medical attention.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">The following evidence-based sleeping tips can be helpful:</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">1) <b>Change your diet to be more conducive to a good night's rest.</b> &nbsp;<a href="http://www.health.com/health/gallery/0,,20628881,00.html?xid=09262012" target="_blank">Some foods are better for sleep than others</a>. &nbsp;Focus on foods high in melatonin, potassium, magnesium, and L-tryptophan, such as cherries, bananas, and milk. &nbsp;Avoid foods high in fat content or carbohydrates. &nbsp;Eliminate both stimulants and depressants in the few hours prior to going to bed. &nbsp;Caffeine and sugar are stimulants; they inhibit sleep. &nbsp;While many people rely on depressants like alcohol or <a href="http://www.addictionpro.com/ME2/dirmod.asp?sid=9B6FFC446FF7486981EA3C0C3CCE4943&amp;nm=ArtIcles%2FNews&amp;type=Publishing&amp;mod=Publications%3A%3AArticle&amp;mid=8F3A7027421841978F18BE895F87F791&amp;tier=4&amp;id=0BD614642BEB480EA54B28BB4F6CB99C">marijuana</a> to help them fall asleep, they are typically unaware that such depressants tend to decrease the amount of time that the brain spends in slow-wave sleep (deeper sleep) and REM sleep. &nbsp;A person may fall asleep and may even sleep for a good number of hours, but they do so at the expense of sleep <b>quality</b>. &nbsp;Also, some foods are better than others for a good night's rest.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">2) <b>Wash your bedding frequently</b>. &nbsp;Personally, I was mine at least once a week. &nbsp;Why does this help? &nbsp;We find fresh scents more relaxing, and dust and debris in the bedding may impact our breathing at night without us even realizing it.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">3) <b>Keep your room temperature low at night.</b> &nbsp;Our body's set temperature decreases at night. &nbsp;While a "comfortable" temperature varies from person to person, <a href="http://www.webmd.com/sleep-disorders/features/cant-sleep-adjust-the-temperature">the range between 65 and 72 degrees is typically recommended</a>. &nbsp;Are you skeptical? &nbsp;Think about it-human beings have always slept better at night, when temperatures are lowest. &nbsp;And we often sought cooler environments (e.g. caves) for sleep in ancient times.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">4) <b>Keep your room as dark as possible and eliminate TVs, radios, and other visual and auditory distraction</b>s. &nbsp;Most people understand why its important for the room to remain dark, but many swear that the TV or radio helps them to fall asleep. &nbsp;Here's the problem-a structure in the brain called the amygdala is constantly scanning the horizon for changes in tactile, visual, and auditory stimuli-even while you sleep. &nbsp;The more noise and lighting changes throughout night (i.e. from a TV set), the more the brain tends to linger in shallower sleep stages. &nbsp;This mechanism is in place to protect us from potential dangers at night. &nbsp;Some people still swear that they can't fall to sleep without a TV or radio, so I advise them to at least consider using a timer that will automatically shut the device down after a set amount of time to avoid distraction throughout the night.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">5) <b>Exercise regularly</b>. &nbsp;Have you ever exhausted yourself physically during the daytime and then found yourself easily passing out at night? &nbsp;This comes down to simple math. &nbsp;If you aren't burning energy during the day, your body finds sleep, which in part serves to re-energize and replenish these energy resources, less necessary. &nbsp;More exercise = more calories burned = more fatigue at night. &nbsp;But there's a catch: Avoid exercising too late at night. &nbsp;It takes time for your body to come down from that energetic state. &nbsp;Best to exercise in the morning, late afternoon, or early evening.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">6) <b>Avoid tossing and turning in your bed.</b> &nbsp;Ideally, your brain needs to associate your bed with rest, not struggle. &nbsp;If you find yourself tossing and turning, its best to get out of bed and do something relaxing, preferably in a different room. &nbsp;Then come back to bed and try again.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">7) <b>Avoid dwelling on negative or stressful thoughts at night.</b> &nbsp;Easier said than done, right? &nbsp;When you dwell on anxious or negative thoughts at night, you may partially or fully active the sympathetic nervous system, which in turn activates your body's fight or flight system, a state incompatible with sleep. &nbsp;Why? &nbsp;Because your brain is perceiving a potential threat-real or imagined-in your environment. &nbsp;There are several strategies that you can use to combat these anxious thoughts at night. &nbsp;You can try thought stopping, a strategy in which you actually tell yourself to stop thinking anxious thoughts and then distract yourself with a cognitive task, such as counting backwards from 500 in increments of 7. &nbsp;Thought dumping or flooding involves getting out of bed, giving yourself an allotted amount of time to dwell on anxious thoughts, preferably scribbling them down rapidly on a notepad, and then giving yourself permission to rest. &nbsp;Why does this work? &nbsp;If you already got all of your thoughts down and immortalized them on paper, then your brain doesn't have to toss them around as much because you're aware that the thoughts have been recorded and can be reviewed the next day. &nbsp;Part of your worrying can be explained by your brain's need to make sure that you remember important things that could become problems. &nbsp;You may also want to see a <a href="http://therapists.psychologytoday.com/rms/">Cognitive Behavioral Therapist</a> to learn how to challenge and replace these thoughts so that they don't keep you up as much at night. &nbsp;Prayer, meditation, jotting things to remember on a pad or planner, and talking to a supportive friend or family member can also be strategies to help reduce your anxious thinking at night.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Okay, so these 7 tips are a start, but they're only a snapshot of dozens of helpful sleep strategies. &nbsp;For more info, visit my "<a href="http://anorton.com/HelpfulLinks.en.html">Helpful Links</a>" page, scroll down to "Sleep Improvement Tips," and review the the articles listed. &nbsp;Happy reading!</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Wishing you a good night's rest,</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Aaron</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Sources: National Sleep Foundation, Psychology Today, Health.com, WebMD</span>Aaron Norton, LMHC, LMFThttp://www.blogger.com/profile/00635484623173913946noreply@blogger.com1